Abstract 16192: Estimating the Cost of Nonadherence to the 2004 Kawasaki Disease Diagnostic Recommendations
Background - In 2004, the American Heart Association (AHA) and American Academy of Pediatrics (AAP) published recommendations for the optimal evaluation and management of patients with Kawasaki Disease (KD). Previous research has demonstrated clinicians effectively utilize the AHA recommendations in diagnosing complete KD (cKD) but do not for the diagnosis of incomplete KD (iKD).
Objective - To evaluate implications including the cost of non-adherence to the AHA recommendations for iKD.
Methods - A retrospective cohort of all patients with an echocardiogram (echo) for evaluation of acute KD between 1/2007 and 9/2010 at a large tertiary care KD referral center was performed. iKD was diagnosed when IVIg was given. Cost of testing, treatment and followup was determined for patients treated for iKD not meeting the AHA diagnostic criteria. Physician and hospital costs were estimated by obtaining 2011 billing fees for each step in the diagnosis assuming recommended testing, treatment, and follow-up were completed.
Results - There were 113 patients evaluated for iKD. IVIg was given to 70 patients diagnosed with iKD. After reviewing clinical, laboratory and echo criteria, 46 (66%) of 70 patients treated with IVIg for iKD did not meet the AHA criteria. No coronary artery changes were detected in these patients. Estimated cost of KD evaluation including clinical assessment, laboratories and echo are $5868. Once diagnosed with KD, additional costs include hospitalization for > 36 hours for IVIg treatment at $3700/day, outpatient monitoring with an echo and cardiology follow up visits at 2 and 6 weeks at $3157, and repeat laboratory studies to assure inflammatory marker normalization prior to stopping aspirin at $390. Beginning at time of IVIg administration, total expenditures calculated for 46 patients treated who did not meet diagnostic criteria is $3,311,662.
Conclusion - Children who do not meet clinical criteria for the diagnosis of iKD undergo evaluation leading to increased testing, unnecessary treatment and follow up. The effects include substantial monetary burden for continued medical evaluation coupled with the personal cost to the family including time off work/school and the psychological impact associated with a significant medical diagnosis.
- © 2011 by American Heart Association, Inc.