Source:Medina LS, Richardson RR, Crone K. Children with suspected craniosynostosis: a cost-effectiveness analysis of diagnostic strategies.
AJR.
2002
;
179
:
215
–221.

In this 2 1/2-year prospective study from Miami Children’s Hospital and Children’s Medical Center of Cincinnati of 115 infants presenting with unilateral posterior cranial . attening, only 1 child had synostotic posterior plagiocephaly secondary to lambdoid suture synostosis whereas 114 infants had deformation posterior plagiocephaly. This study was undertaken to evaluate the clinical and economic impact of 3 evaluation strategies in children who differed in their risk of craniosynostosis. Three evaluation strategies used were: no imaging, radiography (if abnormal, was followed by 3-dimensional CT [3D-CT]), and 3D-CT. Three risk groups were analyzed on the basis of the prevalence of disease: low (prevalence 34/100,000); intermediate (healthy children with head deformity, prevalence 1/115); and high risk (children with syndromic craniofacial disorders, prevalence 9–10/10).

The results of the analysis were summarized in cost-effectiveness ratios showing the cost of achieving one quality-adjusted life year (QALY) gained for different risk groups and diagnostic strategies. In the low-risk group, the radiographic and 3D-CT strategies resulted in a cost per QALY gained of more than $560,000. In the intermediate-risk group, the radiographic strategy resulted in a cost per quality-adjusted life year gained of$54,600.

Three-dimensional-CT was more effective than the other 2 strategies, but at a higher cost with a cost per QALY gained of $374,200. In the high-risk group, 3D-CT was the most effective strategy with a cost per QALY gained of$33,800. Less experienced radiologists and poor quality studies increased the evaluation cost per QALY gained for all of the risk groups. The outcome suggests that radiologic screening of healthy children at low risk for synostosis is unwarranted; in healthy children with a head deformity at intermediate risk, the radiographic strategy has a reasonable cost per QALY gained, with 3D-CT more effective but with higher cost per QALY. In children with syndromic craniofacial disorders who are at high-risk, 3D-CT is the most effective strategy and has a reasonable cost per QALY gained. Children with high-risk, syndrome-related craniosynostosis should be evaluated thoroughly with imaging performed and interpreted by experienced radiologists. This group will benefit from early intervention.

Craniosynostosis, the early fusion of skull sutures, requires an accurate diagnosis before treatment. Both isolated and syndrome-related craniosynostosis contribute to the prevalence in the general population of 34 to 48 per 100,000 live births with nonsyndromic causes being the most common.1,2 Sagittal suture synostosis accounts for 56% of cases with coronal suture synostosis accounting for 22%.1 In the last 10 years there has been an exponential increase in infants with deformational posterior cranial plagiocephaly, likely related to the recommendation that infants sleep in the supine position and increased general awareness of plagiocephaly. Appropriate management of posterior plagiocephaly3 requires differentiation of occipitoparietal flattening caused by lambdoid synostosis from deformation due to external forces. In view of the very high costs of imaging required for early management of craniosynostosis, this cost-effectiveness analysis provides...