Cost-effectiveness of Imaging Protocols for Suspected Appendicitis.

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  • Additional Information
    • Source:
      Publisher: American Academy of Pediatrics Country of Publication: United States NLM ID: 0376422 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1098-4275 (Electronic) Linking ISSN: 00314005 NLM ISO Abbreviation: Pediatrics Subsets: Core Clinical (AIM); MEDLINE
    • Publication Information:
      Publication: Elk Grove Village Il : American Academy of Pediatrics
      Original Publication: Springfield, Ill., Thomas.
    • Subject Terms:
    • Abstract:
      Background: Inaccurate diagnosis of appendicitis leads to increased costs and morbidity. Ultrasound costs less than computed tomography (CT) or MRI but has lower sensitivity and may not visualize the appendix.
      Methods: We conducted a cost-effectiveness analysis using a decision-analytic model of 10 imaging strategies for suspected appendicitis in a hypothetical cohort of patients: no imaging with discharge or surgery; CT only; MRI only; or staged approach with CT or MRI after 1) negative ultrasound result or ultrasound without appendix visualization, 2) ultrasound without appendix visualization, or 3) ultrasound without appendix visualization but with secondary signs of inflammation. Inputs were derived from published literature and secondary data (quality-of-life and cost data). Sensitivity analyses varied risk of appendicitis and proportion of visualized ultrasound. Outcomes were effectiveness (quality-adjusted life-years [QALYs]), total direct medical costs, and cost-effectiveness (cost per QALY gained).
      Results: The most cost-effective strategy for patients at moderate risk for appendicitis is initial ultrasound, followed by CT if the appendix is not visualized but secondary signs are present (cost of $4815.03; effectiveness of 0.99694 QALYs). Other strategies were well above standard willingness-to-pay thresholds or were more costly and less effective. Cost-effectiveness was sensitive to patients' risk of appendicitis but not the proportion of visualized appendices.
      Conclusions: Tailored approaches to imaging based on patients' risk of appendicitis are the most cost-effective. Imaging is not cost-effective in patients with a probability <16% or >95%. For moderate-risk patients, ultrasound without secondary signs of inflammation is sufficient even without appendix visualization.
      (Copyright © 2020 by the American Academy of Pediatrics.)
    • Comments:
      Comment in: Pediatrics. 2020 Feb;145(2):. (PMID: 31964757)
    • Publication Date:
      Date Created: 20200123 Date Completed: 20200416 Latest Revision: 20200416
    • Publication Date:
      20200527
    • Accession Number:
      10.1542/peds.2019-1352
    • Accession Number:
      31964758
  • Citations
    • ABNT:
      JENNINGS, R. et al. Cost-effectiveness of Imaging Protocols for Suspected Appendicitis. Pediatrics, [s. l.], v. 145, n. 2, 2020. DOI 10.1542/peds.2019-1352. Disponível em: http://widgets.ebscohost.com/prod/customlink/proxify/proxify.php?count=1&encode=0&proxy=&find_1=&replace_1=&target=http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=mdc&AN=31964758&authtype=sso&custid=s5834912. Acesso em: 4 jul. 2020.
    • AMA:
      Jennings R, Guo H, Goldin A, Wright DR. Cost-effectiveness of Imaging Protocols for Suspected Appendicitis. Pediatrics. 2020;145(2). doi:10.1542/peds.2019-1352.
    • AMA11:
      Jennings R, Guo H, Goldin A, Wright DR. Cost-effectiveness of Imaging Protocols for Suspected Appendicitis. Pediatrics. 2020;145(2). doi:10.1542/peds.2019-1352
    • APA:
      Jennings, R., Guo, H., Goldin, A., & Wright, D. R. (2020). Cost-effectiveness of Imaging Protocols for Suspected Appendicitis. Pediatrics, 145(2). https://doi.org/10.1542/peds.2019-1352
    • Chicago/Turabian: Author-Date:
      Jennings, Rebecca, He Guo, Adam Goldin, and Davene R Wright. 2020. “Cost-Effectiveness of Imaging Protocols for Suspected Appendicitis.” Pediatrics 145 (2). doi:10.1542/peds.2019-1352.
    • Harvard:
      Jennings, R. et al. (2020) ‘Cost-effectiveness of Imaging Protocols for Suspected Appendicitis’, Pediatrics, 145(2). doi: 10.1542/peds.2019-1352.
    • Harvard: Australian:
      Jennings, R, Guo, H, Goldin, A & Wright, DR 2020, ‘Cost-effectiveness of Imaging Protocols for Suspected Appendicitis’, Pediatrics, vol. 145, no. 2, viewed 4 July 2020, .
    • MLA:
      Jennings, Rebecca, et al. “Cost-Effectiveness of Imaging Protocols for Suspected Appendicitis.” Pediatrics, vol. 145, no. 2, Feb. 2020. EBSCOhost, doi:10.1542/peds.2019-1352.
    • Chicago/Turabian: Humanities:
      Jennings, Rebecca, He Guo, Adam Goldin, and Davene R Wright. “Cost-Effectiveness of Imaging Protocols for Suspected Appendicitis.” Pediatrics 145, no. 2 (February 2020). doi:10.1542/peds.2019-1352.
    • Vancouver/ICMJE:
      Jennings R, Guo H, Goldin A, Wright DR. Cost-effectiveness of Imaging Protocols for Suspected Appendicitis. Pediatrics [Internet]. 2020 Feb [cited 2020 Jul 4];145(2). Available from: http://widgets.ebscohost.com/prod/customlink/proxify/proxify.php?count=1&encode=0&proxy=&find_1=&replace_1=&target=http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=mdc&AN=31964758&authtype=sso&custid=s5834912