Echocardiography available directly to primary care physicians represents an alternative strategy to pediatric cardiology consultation for childhood heart murmur evaluation. A decision analysis model compared the costs of two diagnostic strategies: (1) echocardiography first, referral to the cardiologist if appropriate; and (2) cardiologist evaluates murmur, echocardiography if appropriate. The model incorporated probability of heart disease, frequency of cardiologist-ordered echocardiography, and echocardiography results established by review of 388 records of consecutive patients evaluated for murmurs in a pediatric cardiology clinic. Echocardiography-first strategy costs were $257 greater than referral-strategy costs. Referral-strategy advantages were not highly sensitive to changes in model assumptions. Pediatric cardiology consultation is the preferred approach provided (1) consultation costs are moderate, (2) echocardiography costs are moderate to high, and (3) the rate at which the cardiologist orders echocardiography for patients with innocent murmurs is low.
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February 1993
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February 01 1993
Cost Assessment of the Evaluation of Heart Murmurs in Children
Pediatrics (1993) 91 (2): 365–368.
Article history
Received:
May 18 1992
Accepted:
August 11 1992
Citation
David A. Danford, Carl Gumbiner, Arwa Nasir; Cost Assessment of the Evaluation of Heart Murmurs in Children. Pediatrics February 1993; 91 (2): 365–368. 10.1542/peds.91.2.365
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