title: The diagnostic evaluation of children with cyclic vomiting: a cost-effectiveness assessment.
abstract: Because patients with cyclic vomiting often (82%) have a family history of migraines and often (60%) respond to antimigraine therapy, we investigated whether an initial therapeutic trial could precede diagnostic testing. We used a decision analysis program to compare the cost and benefit of three initial treatment strategies. The costs of the three strategies were extensive diagnostic evaluation, $3020; empiric treatment alone, $1830, and upper GI series with small-bowel follow-through (UGI-SBFT) plus empiric treatment, $1600, respectively. When compared with the extensive evaluation strategy, initial antimigraine treatment avoided 65% of the esophagogastroduodenoscopys. On the basis of this decision analysis, a UGI-SBFT plus empiric migraine therapy was the most cost-effective initial strategy to treat cyclic vomiting syndrome. The cost of complications of a missed malrotation with volvulus was higher than that of adding a UGI-SBFT to each evaluation.
authors.affiliation: C. S. Mott Children's Hospital and the University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Allan D
authors.initials: AD
authors.lastname: Olson
authors.forename: B U K
authors.initials: BU
authors.lastname: Li
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D017046:Cost Savings; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016099:Endoscopy, Gastrointestinal / Q000191:economics; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000175:diagnosis; D007421:Intestine, Small / Q000000981:diagnostic imaging; D008881:Migraine Disorders / Q000150:complications / Q000188:drug therapy; D011859:Radiography; D014839:Vomiting / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000628:therapy*
chemical_list: D000700:Analgesics