This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Glotzer, D. E. Articles by Bauchner, H. Search for Related Content PubMed PubMed Citation Articles by Glotzer, D. E. Articles by Bauchner, H. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB (D)-PENICILLAMINE ETHYLENEDIAMINE TETRAACETIC ACID LEAD COMPOUNDS Medline Plus Health Information Lead Poisoning Social Bookmarking                   What's this?

Management of Childhood Lead Poisoning

Clinical Impact and Cost-Effectiveness

Kenneth A. Freedberg, MD, MSc

Howard Bauchner, MD

Objectives. No consensus exists regarding the preferred treatment of childhood lead poi soning. The authors used decision analysis to compare the clinical impacts and cost-ef fectiveness of four management strategies for childhood lead poisoning, and to investigate how effective chelation therapy must be in reducing neuropsychologic sequelae to warrant its use. Methods. The model was based on a 2-year-old child with moderate lead poisoning [blood lead level 1.21 to 1.88 µmol/L (25 to 39 µg/dL)]. The following strategies were compared: 1) no treatment; 2) EDTA provocation testing, followed by chelation if testing is positive (PROV); 3) penicillamine chelation with crossover to EDTA provocation testing if toxicity occurs (PCA); 4) EDTA provocation testing with crossover to penicillamine chelation if testing is negative (EDTA). Results. The EDTA and PCA strategies prevented 22.5% of the cases of reading disability and resulted in an increase of 1.02 quality-adjusted life years compared with no treatment. When the costs of outpatient EDTA testing and chelation are considered, the EDTA strategy is more cost-effective than the PCA strategy; when inpatient costs are considered, the PCA strategy becomes more cost-effective. When costs of remedial education are considered, all strategies are cost-saving compared with no treatment if che lation reduces the risk of lead-induced reading disability by more than 20%. Conclusions. Treatment strategies for childhood lead poisoning vary in clinical impact, cost, and cost- effectiveness. Chelation of the 1.4% of United States preschoolers whose blood lead levels are 1.21 µmol/L (25 µg/dL) or higher could prevent more than 45,000 cases of reading disability, and save more than $900 million per year in overall costs when the costs of remedial education are considered. Key words: lead poisoning; decision analysis; cost anal ysis ; chelation. (Med Decis Making 1995;15:13-24)

Medical Decision Making, Vol. 15, No. 1, 13-23 (1995)
DOI: 10.1177/0272989X9501500104


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				N. B. Jain, F. Laden, U. Guller, A. Shankar, S. Kazani, and E. Garshick Relation between Blood Lead Levels and Childhood Anemia in India Am. J. Epidemiol., May 15, 2005; 161(10): 968 - 973. [Abstract] [Full Text] [PDF]

				I. Griebsch, J. Coast, and J. Brown Quality-Adjusted Life-Years Lack Quality in Pediatric Care: A Critical Review of Published Cost-Utility Studies in Child Health Pediatrics, May 1, 2005; 115(5): e600 - e614. [Abstract] [Full Text] [PDF]

				M. J. Brown Costs and Benefits of Enforcing Housing Policies to Prevent Childhood Lead Poisoning Med Decis Making, December 1, 2002; 22(6): 482 - 492. [Abstract] [PDF]

				A. R. Kemper, W. C. Bordley, and S. M. Downs Cost-effectiveness Analysis of Lead Poisoning Screening Strategies Following the 1997 Guidelines of the Centers for Disease Control and Prevention Arch Pediatr Adolesc Med, December 1, 1998; 152(12): 1202 - 1208. [Abstract] [Full Text] [PDF]

				R. Casey, C. Wiley, R. Rutstein, and J. Pinto-Martin Longitudinal Assessment for Lead Poisoning Clinical Pediatrics, February 1, 1996; 35(2): 58 - 61. [Abstract] [PDF]