Cost assessment of the evaluation of heart murmurs in children

D. A. Danford, A. Nasir, C. Gumbiner

Research output: Contribution to journalArticlepeer-review

95 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)365-368
Number of pages4
Issue number2
StatePublished - 1993


  • congenital heart disease
  • cost assessment
  • echocardiography
  • heart murmur

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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