Management of the Child with Wolff‐Parkinson‐White Syndrome and Supraventricular Tachycardia:
Identifieur interne : 000662 ( Main/Corpus ); précédent : 000661; suivant : 000663Management of the Child with Wolff‐Parkinson‐White Syndrome and Supraventricular Tachycardia:
Auteurs : Arthur Garson ; Ronald J. KanterSource :
- Journal of Cardiovascular Electrophysiology [ 1045-3873 ] ; 1997-11.
English descriptors
- KwdEn :
Abstract
Management of the Child with WPW. In the next decade, “better” management will be defined by cost effectiveness including morbidity, mortality, and cost. We used a cost‐effectiveness model for children with Wolff‐Parkinson‐White syndrome (WPW) and supraventricular tachycardia (SVT) comparing medical, surgical, and catheter ablative treatment between age 5 years (estimated average age at first recurrence after infancy) and age 21. Charges were quantitated from actual hospital bills; mortality was estimated from the literature; morbidity was assessed by estimating the number of hours in SVT, hours in clinic, hours in routine hospital bed, and hours in hospital intensive care; and the hours were then multiplied by a severity factor, normalized to 1.0 for 1 hour of SVT (0.5 for 1 hour in clinic, 0.75 for routine hospital, and 2.0 for intensive care). Overall charges (5 to 21 years old) for catheter ablation ($17,236) were 39% of surgical management and 57% of medical management; estimated mortality for catheter ablation (5 to 21 years old including failures that reverted to medical management) was 0.15%, which was 10% of medical management and 28% of surgical management; morbidity for catheter ablation was 27.6 units, which was 32% of medical management and 36% of surgical management. Sensitivity analysis demonstrated that the catheter ablation strategy remained preferable throughout the range of plausible values of cost, mortality, and morbidity (including a repeat procedure for initial failures). Therefore, catheter ablation has lower cost, mortality, and morbidity than either medical management or surgery and is the treatment of choice for the child 5 years of age or older with WPW and SVT. This type of analysis can be used for other forms of chronic disease in children.
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DOI: 10.1111/j.1540-8167.1997.tb01024.x
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In the next decade, “better” management will be defined by cost effectiveness including morbidity, mortality, and cost. We used a cost‐effectiveness model for children with Wolff‐Parkinson‐White syndrome (WPW) and supraventricular tachycardia (SVT) comparing medical, surgical, and catheter ablative treatment between age 5 years (estimated average age at first recurrence after infancy) and age 21. Charges were quantitated from actual hospital bills; mortality was estimated from the literature; morbidity was assessed by estimating the number of hours in SVT, hours in clinic, hours in routine hospital bed, and hours in hospital intensive care; and the hours were then multiplied by a severity factor, normalized to 1.0 for 1 hour of SVT (0.5 for 1 hour in clinic, 0.75 for routine hospital, and 2.0 for intensive care). Overall charges (5 to 21 years old) for catheter ablation ($17,236) were 39% of surgical management and 57% of medical management; estimated mortality for catheter ablation (5 to 21 years old including failures that reverted to medical management) was 0.15%, which was 10% of medical management and 28% of surgical management; morbidity for catheter ablation was 27.6 units, which was 32% of medical management and 36% of surgical management. Sensitivity analysis demonstrated that the catheter ablation strategy remained preferable throughout the range of plausible values of cost, mortality, and morbidity (including a repeat procedure for initial failures). Therefore, catheter ablation has lower cost, mortality, and morbidity than either medical management or surgery and is the treatment of choice for the child 5 years of age or older with WPW and SVT. This type of analysis can be used for other forms of chronic disease in children.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>ARTHUR GARSON Jr., M.D., M.P.H.</name><affiliations><json:string>Baylor College of Medicine, Houston, Texas</json:string></affiliations></json:item><json:item><name>RONALD J. KANTER M.D.</name><affiliations><json:string>Duke University Medical Center, Durham, North Carolina</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>arrhythmia</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>outcomes research</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>sudden death</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>morbidity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>mortality</value></json:item></subject><articleId><json:string>JCE1320</json:string></articleId><language><json:string>eng</json:string></language><abstract>Management of the Child with WPW. In the next decade, “better” management will be defined by cost effectiveness including morbidity, mortality, and cost. We used a cost‐effectiveness model for children with Wolff‐Parkinson‐White syndrome (WPW) and supraventricular tachycardia (SVT) comparing medical, surgical, and catheter ablative treatment between age 5 years (estimated average age at first recurrence after infancy) and age 21. Charges were quantitated from actual hospital bills; mortality was estimated from the literature; morbidity was assessed by estimating the number of hours in SVT, hours in clinic, hours in routine hospital bed, and hours in hospital intensive care; and the hours were then multiplied by a severity factor, normalized to 1.0 for 1 hour of SVT (0.5 for 1 hour in clinic, 0.75 for routine hospital, and 2.0 for intensive care). Overall charges (5 to 21 years old) for catheter ablation ($17,236) were 39% of surgical management and 57% of medical management; estimated mortality for catheter ablation (5 to 21 years old including failures that reverted to medical management) was 0.15%, which was 10% of medical management and 28% of surgical management; morbidity for catheter ablation was 27.6 units, which was 32% of medical management and 36% of surgical management. Sensitivity analysis demonstrated that the catheter ablation strategy remained preferable throughout the range of plausible values of cost, mortality, and morbidity (including a repeat procedure for initial failures). Therefore, catheter ablation has lower cost, mortality, and morbidity than either medical management or surgery and is the treatment of choice for the child 5 years of age or older with WPW and SVT. 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Fax: 713‐770‐1005.</p></note><affiliation>Baylor College of Medicine, Houston, Texas</affiliation></author><author><persName><forename type="first">RONALD J.</forename><surname>KANTER</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Duke University Medical Center, Durham, North Carolina</affiliation></author></analytic><monogr><title level="j">Journal of Cardiovascular Electrophysiology</title><idno type="pISSN">1045-3873</idno><idno type="eISSN">1540-8167</idno><idno type="DOI">10.1111/(ISSN)1540-8167</idno><imprint><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="1997-11"></date><biblScope unit="volume">8</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1320">1320</biblScope><biblScope unit="page" to="1326">1326</biblScope></imprint></monogr><idno type="istex">CCE46155E2671F35B3AC481A688D7F1152A19853</idno><idno type="DOI">10.1111/j.1540-8167.1997.tb01024.x</idno><idno type="ArticleID">JCE1320</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1997</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Management of the Child with WPW. In the next decade, “better” management will be defined by cost effectiveness including morbidity, mortality, and cost. We used a cost‐effectiveness model for children with Wolff‐Parkinson‐White syndrome (WPW) and supraventricular tachycardia (SVT) comparing medical, surgical, and catheter ablative treatment between age 5 years (estimated average age at first recurrence after infancy) and age 21. Charges were quantitated from actual hospital bills; mortality was estimated from the literature; morbidity was assessed by estimating the number of hours in SVT, hours in clinic, hours in routine hospital bed, and hours in hospital intensive care; and the hours were then multiplied by a severity factor, normalized to 1.0 for 1 hour of SVT (0.5 for 1 hour in clinic, 0.75 for routine hospital, and 2.0 for intensive care). Overall charges (5 to 21 years old) for catheter ablation ($17,236) were 39% of surgical management and 57% of medical management; estimated mortality for catheter ablation (5 to 21 years old including failures that reverted to medical management) was 0.15%, which was 10% of medical management and 28% of surgical management; morbidity for catheter ablation was 27.6 units, which was 32% of medical management and 36% of surgical management. Sensitivity analysis demonstrated that the catheter ablation strategy remained preferable throughout the range of plausible values of cost, mortality, and morbidity (including a repeat procedure for initial failures). Therefore, catheter ablation has lower cost, mortality, and morbidity than either medical management or surgery and is the treatment of choice for the child 5 years of age or older with WPW and SVT. This type of analysis can be used for other forms of chronic disease in children.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>arrhythmia</term></item><item><term>outcomes research</term></item><item><term>sudden death</term></item><item><term>morbidity</term></item><item><term>mortality</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1997-11">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/CCE46155E2671F35B3AC481A688D7F1152A19853/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1540-8167</doi><issn type="print">1045-3873</issn><issn type="electronic">1540-8167</issn><idGroup><id type="product" value="JCE"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY">Journal of Cardiovascular Electrophysiology</title></titleGroup></publicationMeta><publicationMeta level="part" position="11011"><doi origin="wiley">10.1111/jce.1997.8.issue-11</doi><numberingGroup><numbering type="journalVolume" number="8">8</numbering><numbering type="journalIssue" number="11">11</numbering></numberingGroup><coverDate startDate="1997-11">November 1997</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="0132000" status="forIssue"><doi origin="wiley">10.1111/j.1540-8167.1997.tb01024.x</doi><idGroup><id type="unit" value="JCE1320"></id></idGroup><countGroup><count type="pageTotal" number="7"></count></countGroup><titleGroup><title type="tocHeading1">CREATIVE MUSINGS</title></titleGroup><eventGroup><event type="firstOnline" date="2007-04-20"></event><event type="publishedOnlineFinalForm" date="2007-04-20"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.2 mode:FullText source:HeaderRef result:HeaderRef" date="2010-03-10"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-29"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-23"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="1320">1320</numbering><numbering type="pageLast" number="1326">1326</numbering></numberingGroup><correspondenceTo>Arthur Garson, Jr., M.D., M.P.H., Professor, Department of Pediatrics, Texas Children's Hospital, 6621 Fannin Street, MC 1‐4460, Houston, TX 77030. 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In the next decade, “better” management will be defined by cost effectiveness including morbidity, mortality, and cost. We used a cost‐effectiveness model for children with Wolff‐Parkinson‐White syndrome (WPW) and supraventricular tachycardia (SVT) comparing medical, surgical, and catheter ablative treatment between age 5 years (estimated average age at first recurrence after infancy) and age 21. Charges were quantitated from actual hospital bills; mortality was estimated from the literature; morbidity was assessed by estimating the number of hours in SVT, hours in clinic, hours in routine hospital bed, and hours in hospital intensive care; and the hours were then multiplied by a severity factor, normalized to 1.0 for 1 hour of SVT (0.5 for 1 hour in clinic, 0.75 for routine hospital, and 2.0 for intensive care). Overall charges (5 to 21 years old) for catheter ablation ($17,236) were 39% of surgical management and 57% of medical management; estimated mortality for catheter ablation (5 to 21 years old including failures that reverted to medical management) was 0.15%, which was 10% of medical management and 28% of surgical management; morbidity for catheter ablation was 27.6 units, which was 32% of medical management and 36% of surgical management. Sensitivity analysis demonstrated that the catheter ablation strategy remained preferable throughout the range of plausible values of cost, mortality, and morbidity (including a repeat procedure for initial failures). Therefore, catheter ablation has lower cost, mortality, and morbidity than either medical management or surgery and is the treatment of choice for the child 5 years of age or older with WPW and SVT. 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Fax: 713‐770‐1005.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">RONALD J.</namePart><namePart type="family">KANTER</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Duke University Medical Center, Durham, North Carolina</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">1997-11</dateIssued><edition>Manuscript received 10 December 1996; Accepted for publication 22 April 1997</edition><copyrightDate encoding="w3cdtf">1997</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="references">12</extent></physicalDescription><abstract lang="en">Management of the Child with WPW. In the next decade, “better” management will be defined by cost effectiveness including morbidity, mortality, and cost. We used a cost‐effectiveness model for children with Wolff‐Parkinson‐White syndrome (WPW) and supraventricular tachycardia (SVT) comparing medical, surgical, and catheter ablative treatment between age 5 years (estimated average age at first recurrence after infancy) and age 21. Charges were quantitated from actual hospital bills; mortality was estimated from the literature; morbidity was assessed by estimating the number of hours in SVT, hours in clinic, hours in routine hospital bed, and hours in hospital intensive care; and the hours were then multiplied by a severity factor, normalized to 1.0 for 1 hour of SVT (0.5 for 1 hour in clinic, 0.75 for routine hospital, and 2.0 for intensive care). Overall charges (5 to 21 years old) for catheter ablation ($17,236) were 39% of surgical management and 57% of medical management; estimated mortality for catheter ablation (5 to 21 years old including failures that reverted to medical management) was 0.15%, which was 10% of medical management and 28% of surgical management; morbidity for catheter ablation was 27.6 units, which was 32% of medical management and 36% of surgical management. Sensitivity analysis demonstrated that the catheter ablation strategy remained preferable throughout the range of plausible values of cost, mortality, and morbidity (including a repeat procedure for initial failures). Therefore, catheter ablation has lower cost, mortality, and morbidity than either medical management or surgery and is the treatment of choice for the child 5 years of age or older with WPW and SVT. This type of analysis can be used for other forms of chronic disease in children.</abstract><subject lang="en"><genre>Keywords</genre><topic>arrhythmia</topic><topic>outcomes research</topic><topic>sudden death</topic><topic>morbidity</topic><topic>mortality</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Cardiovascular Electrophysiology</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">1045-3873</identifier><identifier type="eISSN">1540-8167</identifier><identifier type="DOI">10.1111/(ISSN)1540-8167</identifier><identifier type="PublisherID">JCE</identifier><part><date>1997</date><detail type="volume"><caption>vol.</caption><number>8</number></detail><detail type="issue"><caption>no.</caption><number>11</number></detail><extent unit="pages"><start>1320</start><end>1326</end><total>7</total></extent></part></relatedItem><identifier type="istex">CCE46155E2671F35B3AC481A688D7F1152A19853</identifier><identifier type="DOI">10.1111/j.1540-8167.1997.tb01024.x</identifier><identifier type="ArticleID">JCE1320</identifier><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Ltd</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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