Practical Review of the Cost of Diagnosis and Management of Positional Plagiocephaly

Abstract

Background: Positional plagiocephaly has garnered increased research interest since the introduction of the Back to Sleep campaign in the 1990s, and the subsequent increase in infants with cranial deformity. Research has focused on treatment outcomes and developing new modalities to address asymmetric heads. Little attention has been given to the cost of treatment and diagnosis. This study aimed to summarize the literature and provide an overview of the costs associated with a diagnosis of positional plagiocephaly. Methods: A literature review was performed by searching PubMed and Ovid Embase to identify studies pertaining to the “cost” of plagiocephaly diagnosis or treatment through direct financial factors, disturbance to daily routines (ie, through treatment prolongation), or related stress. Results: Twenty-nine peer-reviewed studies were included. Treatment options for plagiocephaly are stratified by severity and age of diagnosis, with different pathways available to treat different stages of asymmetry. The common factor across all treatment modalities is that earlier diagnosis unequivocally leads to better aesthetic outcomes and shorter treatment times. This leads to lower costs for treatment, a lower stress burden for parents, and lower costs for the healthcare system in the future through reduction of long-term effects. Our theoretical cost model suggests that early diagnosis at 4 months can lead to a treatment cost of $1495, when compared with $5195 for detection of deformity at or after 6 months. Conclusion: The dramatic cost disparity between early and late diagnosis highlights the need for reliable methods to accurately detect cranial deformity early in an infant’s life.

Parental Education for the Prevention of Plagiocephaly

“…Theoretical cost models estimate the individual cost of diagnosis and treatment of plagiocephaly between $1495 to more than $5000 depending on timing of diagnosis with diagnosis after 6 months incurring the most cost. 15 We found that parental education at the newborn visit led to decreases in CI at 2 and 4 months compared with control patients, which is relevant as this seems to be the ideal timing for intervention. In summary, we would expect to see a reduction in physician visits, referring surgeons' time, and helmeting therapy among the target population with the addition of plagiocephaly education to the current Back to Sleep lexicon.…”

“…Plagiocephaly is associated with significant health care costs, making prevention of particular importance. Theoretical cost models estimate the individual cost of diagnosis and treatment of plagiocephaly between $1495 to more than $5000 depending on timing of diagnosis with diagnosis after 6 months incurring the most cost 15 . We found that parental education at the newborn visit led to decreases in CI at 2 and 4 months compared with control patients, which is relevant as this seems to be the ideal timing for intervention.…”

Smartphone Integration of Artificial Intelligence for Automated Plagiocephaly Diagnosis

“…Conversely, a positive trend in cranial symmetry after at-home implementation of additional tummy time and physiotherapy may indicate a resolving plagiocephaly requiring monitoring but no additional consultation. 11,29 Recent events have highlighted an urgent need for improved modalities to provide adequate care remotely with telemedicine. 30,31 Rizvi et al, alongside Marianayagam et al, have released studies evaluating the outcomes of virtual craniofacial clinics for the assessment of positional plagiocephaly based on standard digital images, concluding that virtual encounters resulted in comparable diagnostic accuracy.…”

“…In a previous study, the authors demonstrated that earlier diagnosis is associated with better aesthetic outcomes, shorter treatment times, lower costs for treatment, a lower stress burden for parents, and lower costs for the healthcare system overall. 11 In large part, this is due to early detection maximizing the chance of successful intervention with repositioning and physical therapy, negating the need to progress to helmet therapy or, in extreme cases, surgery. 11 It is not surprising then that various techniques have been developed to accurately and efficiently diagnose head deformities in the pediatric population.…”

Barriers and facilitators influencing parental adherence to prevention strategies for deformational plagiocephaly: Results from a scoping review

“…within the first weeks of life) (Ellwood et al, 2020). Indeed, when parents of newborns are made aware that prevention strategies exist, their babies are two to four times less likely to develop DP (Aarnivala et al, 2015; Cavalier et al, 2011; Lennartsson & Nordin, 2019; Leung et al, 2018), and the costs associated with diagnosis and treatment, which vary between $1495 and $5195 US, can be avoided (Watt et al, 2022).…”