title: Cost-effectiveness of diagnostic approaches to suspected appendicitis in children.
abstract: BACKGROUND
  Our group recently published a clinical pathway (Le Bonheur Clinical Pathway [LeB-P]) that used the Samuel Pediatric Appendicitis Score with selective use of ultrasonography (USG) for diagnosis of children at risk for appendicitis. The objective of this study was to model the cost-effectiveness of implementing the LeB-P compared with usual care.
  
  
  METHODS
  We constructed a decision analytic model comparing hospital costs for the following diagnostic strategies for suspected appendicitis: emergency department clinician judgment alone, USG on all patients, CT on all patients, overnight observation with surgical evaluation without studies, and the LeB-P. Prevalence of disease, outcomes probabilities, and hospital and professional costs for each option were derived from published literature, national cost data, and our previous study results. Cost-effectiveness was calculated using these 3 sets of parameters.
  
  
  RESULTS
  In the base case model, USG was the preferred strategy over LeB-P and overnight observation with surgical evaluation without studies. Emergency department clinician judgment alone and CT were dominated by the other pathways, based on either lower diagnostic accuracy or increased costs. Compared with LeB-P, USG costs $337 less per patient evaluated, but increased the diagnostic error rate by 2%. Using LeB-P rather than USG would cost an institution an additional $17,206 to eliminate one misdiagnosis, which is known as the incremental cost-effectiveness ratio.
  
  
  CONCLUSIONS
  Although performing USG on all children with suspected appendicitis was determined to be the most cost-effective strategy, using the Pediatric Appendicitis Score with selective use of USG (LeB-P) improved diagnostic accuracy at a moderate increase in cost and decreased CT use.
authors: Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors: Jay
authors: J
authors: Pershad
authors: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors: Teresa M
authors: TM
authors: Waters
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors: Max R
authors: MR
authors: Langham
authors: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors: Tao
authors: T
authors: Li
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN. Electronic address: ehuang@uthsc.edu.
authors: Eunice Y
authors: EY
authors: Huang
mesh_terms: D000293:Adolescent; D001064:Appendicitis / Q000175:diagnosis* / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013714:Tennessee; D014057:Tomography, X-Ray Computed / Q000191:economics*