title: Intussusception in children: cost-effectiveness of ultrasound vs diagnostic contrast enema.
abstract: OBJECTIVE
  The aim of the study was to compare the cost-effectiveness of different imaging strategies for the diagnosis of pediatric intussusception using a decision analytic model.
  
  
  METHODS
  A Markov decision model was constructed to model effects of radiation exposure at the time of intussusception in a hypothetical cohort of 2-year-old children. The 2 strategies compared were ultrasound followed conditionally by contrast enema (US/CE) vs contrast enema (CE) alone. The model simulated short-term and long-term outcomes of the patients, calculating the average quality-adjusted life years (QALYs) and health care costs associated with each arm.
  
  
  RESULTS
  The use of ultrasound as a first-line diagnostic modality would result in a decrease of 79.3 and 59.7 cases of radiation-induced malignancy per 100,000 male and female children evaluated, respectively. For male and female children with intussusception, US/CE was both the most costly initial imaging strategy and the most effective compared with CE. The incremental cost-effectiveness ratios of US/CE to CE was $70,100 (boy) and $92,227 (girl) per quality-adjusted life years gained.
  
  
  CONCLUSIONS
  In a Markov decision model of pediatric acute intussusception, initial US/CE was both the most costly and the most effective strategy.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA. bucherb@wudosis.wustl.edu
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bucher
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.forename: Brad W
authors.initials: BW
authors.lastname: Warner
authors.forename: Martin S
authors.initials: MS
authors.lastname: Keller
mesh_terms: D001466:Barium Sulfate / Q000191:economics; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004733:Enema / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D007443:Intussusception / Q000175:diagnosis* / Q000191:economics*; D008297:Male; D008390:Markov Chains; D018608:Ultrasonography, Doppler / Q000191:economics* / Q000379:methods
chemical_list: D001466:Barium Sulfate