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

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.