Imaging strategies for suspected acute cranial shunt failure

A cost-effectiveness analysis

Jay Pershad, Andrew Taylor, M. Kennedy Hall, Paul Klimo

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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 lifeyears. 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.

Original languageEnglish (US)
Article numbere20164263
JournalPediatrics
Volume140
Issue number2
DOIs
StatePublished - Aug 1 2017

Fingerprint

Cost-Benefit Analysis
Optic Nerve
Point-of-Care Systems
Magnetic Resonance Imaging
Tomography
Costs and Cost Analysis
Radiation-Induced Neoplasms
Quality-Adjusted Life Years
Diagnostic Imaging
Uncertainty
Ultrasonography
Organizations
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Imaging strategies for suspected acute cranial shunt failure : A cost-effectiveness analysis. / Pershad, Jay; Taylor, Andrew; Hall, M. Kennedy; Klimo, Paul.

In: Pediatrics, Vol. 140, No. 2, e20164263, 01.08.2017.

Research output: Contribution to journalArticle

Pershad, Jay ; Taylor, Andrew ; Hall, M. Kennedy ; Klimo, Paul. / Imaging strategies for suspected acute cranial shunt failure : A cost-effectiveness analysis. In: Pediatrics. 2017 ; Vol. 140, No. 2.
@article{1f8f79fe573c43f68b263d1ea291bf2b,
title = "Imaging strategies for suspected acute cranial shunt failure: A cost-effectiveness analysis",
abstract = "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 lifeyears. 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.",
author = "Jay Pershad and Andrew Taylor and Hall, {M. Kennedy} and Paul Klimo",
year = "2017",
month = "8",
day = "1",
doi = "10.1542/peds.2016-4263",
language = "English (US)",
volume = "140",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "2",

}

TY - JOUR

T1 - Imaging strategies for suspected acute cranial shunt failure

T2 - A cost-effectiveness analysis

AU - Pershad, Jay

AU - Taylor, Andrew

AU - Hall, M. Kennedy

AU - Klimo, Paul

PY - 2017/8/1

Y1 - 2017/8/1

N2 - 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 lifeyears. 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.

AB - 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 lifeyears. 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.

UR - http://www.scopus.com/inward/record.url?scp=85026654118&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85026654118&partnerID=8YFLogxK

U2 - 10.1542/peds.2016-4263

DO - 10.1542/peds.2016-4263

M3 - Article

VL - 140

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 2

M1 - e20164263

ER -