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Evidence-Based Pediatrics Web Site

Cost Effective Screening of Heart Murmurs in Children

Question

  • What is the most cost effective way to screen children diagnosed by their pediatrician with a heart murmur?

Clinical Bottom Lines

  1. EKG and CXR are not cost effective screening tools.
  2. Referral of all patients to cardiology would cost $38,000/ pathologic murmur identified over selective referral.
  3. Referral of all patients to ECHO would cost $158,000/ pathologic murmur identified over selective referral.


Summary of Key Evidence


Strategy

Cost of study
% Lesions Detected
Incremental C-E ratio
Selective to Cards
$72
82%
---

Selective to ECHO

$133
86%
extended dominance
ECG/CXR/sel to Cards
$137
83%
dominated
All to Cards
$174
95%
$38,000/ case
ECG/CXR/sel to ECHO
$200
88%
dominated
All to ECHO
$332
100%
$158,000/ case



Additional Comments

  • This study did not model a strategy of observation only.
  • If pediatrician auscultatory skills improve to 91% sensitivity (from 86%), selective referral to ECHO would cost $66,000/case identified and detect almost all of the pathologic lesions.
  • No distinction was made between the various underlying lesions.
  • This study did not model health care costs of treating the carious lesions.
  • If prevalence increases to 14%, referral of all murmurs to ECHO would cost $18,000/case. This may be a reasonable strategy in special populations.

Citation

  1. Yi MS, Kimball TR, Tsevat J, Mrus JM, and Kotagal UR. Evaluation of heart murmurs in children: Cost-effectiveness and practical implications. Journal of Pediatrics 2002;141, 504-11.

CAT Author: Heather L Burrows, MD, PhD

CAT Appraisers: Jon Fliegel, MD

Date appraised: November 11, 2002

Last updated June 15, 2003
Department of Pediatrics and Communicable Diseases
© 1998-2002 University of Michigan Health System