Revista Panamericana de Salud Pública
Print version ISSN 1020-4989
RODRIGUEZ MARTINEZ, Carlos E. and SOSSA BRICENO, Mónica P.. Cost-effectiveness of chest x-rays in infants with clinically suspected viral bronchiolitis in Colombia. Rev Panam Salud Publica [online]. 2011, vol.29, n.3, pp. 153-161. ISSN 1020-4989. http://dx.doi.org/10.1590/S1020-49892011000300002.
OBJECTIVE: Estimate the cost-effectiveness of not taking chest x-rays of any infant with clinically suspected viral bronchiolitis versus routinely taking them of all such patients, the most common practice today in Colombia. METHODS: A cost-effectiveness study was conducted, comparing strategies of taking chest x-rays of all infants with clinically suspected viral bronchiolitis and not x-raying any of these infants. The principal outcome was the proportion of correct diagnoses. The time horizon was the clinical course of the bronchiolitis. The perspective was that of the third-party payer, and the costs were obtained from the rates in effect in a clinic in Bogotá. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The strategy of not taking a chest x-ray of any patient prevailed over that of routinely taking one in all cases, with an average cost of US$ 111.00 and a correct diagnosis rate of 0.8020, versus the respective values of US$ 129.00 and 0.7873 for the strategy of routinely x-raying all of these patients. The most influential variable was pneumonia-related hospital costs. In the probabilistic sensitivity analysis, the strategy of not x-raying any infant prevailed in 61.1% of the simulations. CONCLUSIONS: The results suggest that not taking routine chest x-rays of infants with clinically suspected viral bronchiolitis is a cost-effective strategy compared with the common practice of taking them in all cases, since the former yields a greater proportion of correct diagnoses at a lower average cost per patient. Nevertheless, new studies will be needed that have more representative samples from all of the health facilities and include the strategy of taking chest x-rays only of patients with predictors of radiologic abnormalities.
Keywords : Bronchiolitis; pneumonia; radiography, thoracic; cost-benefit analysis; child welfare; clinical diagnosis; sensitivity and specificity; Colombia.