PEDIATRICS Vol. 91 No. 2 February 1993, pp. 365-368
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Cost Assessment of the Evaluation of Heart Murmurs in Children

David A. Danford MD1, Carl Gumbiner MD1, and Arwa Nasir MD2

1 From the Departments of Pediatrics, University of Nebraska Medical Center, Omaha Childrens Memorial Hospital, Omaha St Elizabeth Hospital, Lincoln, NE
2 From the Department Childrens Memorial Hospital, Omaha

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.

Key Words: heart murmur • congenital heart disease • echocardiography • cost assessment

Submitted on May 18, 1992
Accepted on August 11, 1992




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