Imaging Strategies for Suspected Acute Cranial Shunt Failure: A Cost-Effectiveness Analysis
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Le résumé fourni par la source
OBJECTIVES: We compared cost-effectiveness of cranial computed tomography (CT), fast sequence magnetic resonance imaging (fsMRI), and ultrasonography measurement of optic nerve sheath diameter (ONSD) for suspected acute shunt failure from the perspective of a health care organization. METHODS: We modeled 4 diagnostic imaging strategies: (1) CT scan, (2) fsMRI, (3) screening ONSD by using point of care ultrasound (POCUS) first, combined with CT, and (4) screening ONSD by using POCUS first, combined with fsMRI. All patients received an initial plain radiographic shunt series (SS). Short- and long-term costs of radiation-induced cancer were assessed with a Markov model. Effectiveness was measured as quality-adjusted life-years. Utilities and inputs for clinical variables were obtained from published literature. Sensitivity analyses were performed to evaluate the effects of parameter uncertainty. RESULTS: At a previous probability of shunt failure of 30%, a screening POCUS in patients with a normal SS was the most cost-effective. For children with abnormal SS or ONSD measurement, fsMRI was the preferred option over CT. Performing fsMRI on all patients would cost $269 770 to gain 1 additional quality-adjusted life-year compared with POCUS. An imaging pathway that involves CT alone was dominated by ONSD and fsMRI because it was more expensive and less effective. CONCLUSIONS: In children with low pretest probability of cranial shunt failure, an ultrasonographic measurement of ONSD is the preferred initial screening test. fsMRI is the more cost-effective, definitive imaging test when compared with cranial CT.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Imaging Strategies for Suspected Acute Cranial Shunt Failure: A Cost-Effectiveness Analysis
- Date Crossref
- 01/08/2017
- Éditeur
- American Academy of Pediatrics (AAP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Tennessee Health Science Center Le Bonheur Children’s Hospital pays non établi dans la noticeUniversité ou école supérieure
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Le Bonheur Children's Hospital pays non établi dans la noticeÉtablissement de santé
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Yale University pays non établi dans la noticeUniversité ou école supérieure
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University of Washington Division of Emergency Medicine pays non établi dans la noticeUniversité ou école supérieure
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Semmes Murphey Foundation pays non établi dans la noticeOrganisation à but non lucratif
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Departments of Pediatrics and pays non établi dans la noticeInstitution
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Yale School of Medicine Department of Emergency Medicine pays non établi dans la noticeUniversité ou école supérieure
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Semmes-Murphey Neurologic & Spine Institute pays non établi dans la noticeStructure de recherche
Le Bonheur Children’s Hospital — University of Tennessee Health Science Center, Le Bonheur Children's Hospital et Yale University, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.