This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Medina, L. S.
Right arrow Articles by Pomeroy, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Medina, L. S.
Right arrow Articles by Pomeroy, S.
Related Collections
Right arrow Office Practice

PEDIATRICS Vol. 108 No. 2 August 2001, pp. 255-263

Children With Headache Suspected of Having a Brain Tumor: A Cost-Effectiveness Analysis of Diagnostic Strategies

Received May 10, 2000; accepted Dec 14, 2000.

L. Santiago Medina*, Karen M. KuntzDagger , and Scott Pomeroy§

From the * Neuroradiology, and Health Outcomes and Policy Section, Department of Radiology, Children's Hospital Medical Center, Cincinnati, Ohio; Dagger  Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts; and § Division of Neuro-Oncology, Department of Neurology, Children's Hospital Medical School, Boston, Massachusetts.

Objective.  To assess the clinical and economic consequences of 3 diagnostic strategies---magnetic resonance imaging (MRI), computed tomography followed by MRI for positive results (CT-MRI), and no neuroimaging with close clinical follow-up---in the evaluation of children with headache suspected of having a brain tumor. Three risk groups based on clinical variables were evaluated.

Materials and Methods.  A decision-analytic Markov model and cost-effectiveness analysis was performed incorporating the risk group prior probability, MRI and CT sensitivity and specificity, tumor survival, progression rates, and cost per strategy. Outcomes were based on quality-adjusted life year (QALY) gained and incremental cost per QALY gained.

Results.  For low-risk children with chronic nonmigraine headaches of >6 months' duration as the sole symptom (prior probability of brain tumor 0.01%), no neuroimaging with close clinical follow-up was less costly and more effective than the 2 neuroimaging strategies. For the intermediate-risk children with migraine headache and normal neurologic examination (prior probability of brain tumor 0.4%), CT-MRI was the most effective strategy but cost >$1 million per QALY gained compared with no neuroimaging. For high-risk children with headache of <6 months' duration and other clinical predictors of a brain tumor such as an abnormal neurologic examination (prior probability of brain tumor 4%), the most effective strategy was MRI, with cost-effectiveness ratio of $113 800 per QALY gained compared with no imaging.

Conclusion.  Our analysis suggests that MRI maximizes QALY gained at a reasonable cost-effectiveness ratio in children with headache at high risk of having a brain tumor. Conversely, the strategy of no imaging with close clinical follow-up is cost saving in low-risk children. Although the CT-MRI strategy maximizes QALY gained in the intermediate-risk patients, its additional cost per QALY gained is high. In children with headache, appropriate selection of patients and diagnostic strategy may maximize quality-adjusted life expectancy and decrease costs of medical workup.  Key words:  headache, children, cost-effectiveness analysis.




This article has been cited by other articles:


Home page
 J Child NeurolHome page
B. C. Reulecke, C. G. Erker, B. J. Fiedler, T.-U. Niederstadt, and G. Kurlemann
Brain Tumors in Children: Initial Symptoms and Their Influence on the Time Span Between Symptom Onset and Diagnosis
J Child Neurol, February 1, 2008; 23(2): 178 - 183.
[Abstract] [PDF]

Home page
 PediatricsHome page
I. Griebsch, J. Coast, and J. Brown
Quality-Adjusted Life-Years Lack Quality in Pediatric Care: A Critical Review of Published Cost-Utility Studies in Child Health
Pediatrics, May 1, 2005; 115(5): e600 - e614.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
D. W. Lewis, S. Ashwal, G. Dahl, D. Dorbad, D. Hirtz, A. Prensky, and I. Jarjour
Practice parameter: Evaluation of children and adolescents with recurrent headaches: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society
Neurology, August 27, 2002; 59(4): 490 - 498.
[Abstract] [Full Text] [PDF]