A. M. Green1, G. J. Ramos-Gonzalez1, J. C. DeRosa1, K. Bartkus8, C. D. Cappiello2, F. Demehri8, S. M. Koenig4, S. M. Kunisaki2, S. E. McLean3, J. A. Meisel6, R. Petroze7, R. T. Russell4, S. Scholz5, D. K. Strepay3, J. Taylor7, C. W. Snyder1, N. M. Chandler1 8Children’s Hospital Boston, Pediatric Surgery, Boston, MA, USA 1John’s Hopkins All Children’s Hospital, Pediatric Surgery, St Petersburg, FL, USA 2The Johns Hopkins University School Of Medicine, Pediatric Surgery, Baltimore, MD, USA 3University Of North Carolina At Chapel Hill, Pediatric Surgery, Chapel Hill, NC, USA 4University Of Alabama at Birmingham, Pediatric Surgery, Birmingham, Alabama, USA 5Children’s Hospital Of Pittsburgh Of UPMC, Pediatric Surgery, Pittsburgh, PA, USA 6Children’s Healthcare of Atlanta, Pediatric Surgery, Atlanta, GA, USA 7University Of Florida, Pediatric Surgery, Gainesville, FL, USA
Introduction:
Patients with pectus excavatum (PE) often undergo cross-sectional imaging (CSI) by computed tomography (CT) or magnetic resonance imaging (MRI) to obtain insurance authorization prior to surgical repair. Although Modified Percent Depth (MPD), calculated from simple external caliper measurements during a physical exam, has been validated in previous studies to be comparable to the Pectus Index in measuring PE severity, insurance companies have not readily accepted it over CSI, which may expose patients to harmful radiation and out-of-pocket costs. This study explored family perceptions of CSI and MPD caliper measurements with respect to their perceived value and costs.
Methods:
This is a sub-analysis of an ongoing prospective multicenter study conducted within a regional research collaborative evaluating the use of MPD caliper measurements as an alternative to CSI in PE. Guardians of patients with PE who had undergone both CSI and MPD were asked to complete a 9-question multiple-choice survey, regarding opinions and time/financial costs associated with CSI and MPD caliper measurements. Survey results were described and associations between responses were evaluated using chi-square and Wilcox rank sum tests.
Results:
Complete survey data was available for 136 patients enrolled from April 2021 to June 2023 across 7 centers. Mean age was 15.6 years and 85% were male. All patients underwent both MPD caliper measurements and cross-sectional imaging (84% CT, 10% MRI, and 7% both). One-hundred seventeen (90%) reported that MPD measurements were a good method to quantify the PE defect and 103 (76%) were confident that the MPD caliper measurements were similar to CSI. An out-of-pocket copay for imaging was reported by 82 respondents (60%), with 63% of these reporting their copay was >$100. Ninety percent reported that imaging required time off from work or school. Nearly half (49%) of respondents reported CSI resulted in hardship related to its financial costs (7%), time requirement (25%), or both (18%). The proportion reporting hardship was 69% for those with a copay >$100, compared to 39% among those with <=$100 copay and 36% with no copay (p=0.002). Overall, 92 (68%) reported feeling reassured by undergoing CSI, but the proportion of those respondents was significantly lower (55%) among those with copays >$100 compared to those with no (75%) or lower (77%) copays (p=0.036).
Conclusion:
The vast majority of guardians reported MPD caliper measurements as an effective way to measure PE severity. Cross-sectional imaging imposes considerable time and financial burdens on families. Those with higher imaging copays reported higher levels of hardship, and conversely lower levels of reassurance with imaging. Eliminating routine cross-sectional imaging from PE workup may improve family satisfaction and perceived value of care.