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Pediatr Pulmonol. 2009 Feb;44(2):122-7. doi: 10.1002/ppul.20948.

A cost effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis.

Author information

1
Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

To carry out a cost-effectiveness analysis of omitting chest radiography in the diagnosis of infant bronchiolitis.

HYPOTHESIS:

Omitting chest radiographs in the diagnosis of typical bronchiolitis was expected to reduce costs without adversely affecting the detection rate of alternate diseases.

STUDY DESIGN:

An economic evaluation was conducted using clinical and health resources. Emergency department (ED) physicians provided diagnoses pre- and post-radiography as well as a management plan. The primary outcome was the diagnostic accuracy (false-negative rate) of alternate diagnoses with and without X-ray. The incremental costs of omitting radiography in comparison to routine radiography per patient were assessed from a health system perspective.

PATIENT SELECTION:

We studied 265 infants, 2-23 months old, presenting at the ED with typical bronchiolitis. Patients with pre-existing conditions or radiographs were omitted from the study.

METHODOLOGY:

Expected costs to the health care system of including and excluding chest radiographs were compared, including costs associated with misdiagnosis.

RESULTS:

All alternate diagnoses (two cases) were missed by ED physicians pre- and post-radiography, resulting in a 100% false negative rate. The specificity in detecting alternate diseases was 96.6% pre-radiography and 88.6% post-radiography. Of the 17 cases of coexistent pneumonia, 88% were missed pre-radiography and 59% post-radiography, with respective false positive rates of 10.5% and 16.1%. Omission of routine chest radiograph saved CDN $59 per patient, primarily due to savings in radiography and hospitalization costs. The economic benefit persisted after the inpatient length of stay, ED overhead and radiograph costs were varied.

CONCLUSION:

For infants with typical bronchiolitis, omitting radiography is cost saving without compromising diagnostic accuracy of alternate diagnoses and of associated pneumonia.

PMID:
19142890
DOI:
10.1002/ppul.20948
[Indexed for MEDLINE]

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