The cost-effectiveness of different strategies to evaluate optic disk drusen in children

Abstract

Purpose: To compare the costs of diagnostic work-up for optic disk drusen where ophthalmic ultrasound was performed prior to imaging and invasive studies with those where ophthalmic ultrasound was performed after such studies.

Methods: The medical records of patients <18 years of age evaluated at a tertiary referral center between 2007 and 2012 for "swollen" optic nerves were retrospectively reviewed. The main outcome measure was cost of diagnostic work-up according to Georgia Medicaid global reimbursement rates.

Results: A total of 46 children with a B-scan ultrasound-confirmed diagnosis of calcified optic disk drusen were included. Neuroimaging was performed in 23 patients, of whom 20 had the study prior to ophthalmic ultrasound. The mean cost of evaluations for patients undergoing ancillary testing prior to ophthalmic ultrasound was $1,173; for those undergoing ancillary testing after, $305.

Conclusions: Because optic disk drusen can mimic the appearance of papilledema, it is more cost-effective to perform ophthalmic ultrasonography prior to neuroimaging, especially when the patient is asymptomatic. If ophthalmic ultrasonography confirms the presence of drusen, it is more cost-effective to reassess the clinical picture before proceeding with further tests.

Fig 1

Right (A) and left (B) optic disk photographs of a 7-year-old boy presenting with optic disk swelling and occasional headaches.

Fig 2

Ophthalmic ultrasound of right (A) and left (B) eyes of the patient in Figure 1, confirming optic disc drusen. No further diagnostic testing was performed.