A cost effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis†
These findings were presented at the University of Toronto Department of Health Policy, Management and Evaluation Graduate Student Union Conference and Annual Research Day, Toronto, Ontario, May 2006, and at the 3rd Annual Canadian Therapeutics Congress, May 2006.
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. Pediatr Pulmonol. 2009; 44:122–127. © 2009 Wiley-Liss, Inc.
