The cost-effectiveness of neonatal surgery and subsequent treatment for congenital anorectal malformations.
OBJECTIVE
The progress made in all fields of medicine, including neonatal surgery, has contributed to the rise in healthcare costs. Although neonatal surgery may provide survival gains, these could be at the expense of worse quality of life caused by impairment after surgery. For example, congenital anorectal malformations (CAM) are complex anomalies, and the surgical techniques available have their limitations in achieving continence. It therefore seems justifiable to consider what the effects of treatment are in relation to the costs. Evidence of the cost-effectiveness of neonatal surgery, however, is lacking.


METHODS
The authors analyzed both direct and indirect, medical and nonmedical costs in patients who had undergone treatment for CAM. Quality-adjusted life years (QALYs) were measured using the EuroQol EQ-5D questionnaire. Descriptive quality-of-life data were collected using a disease-specific questionnaire and a medical consumption questionnaire.


RESULTS
Mean costs of treatment are calculated at Euro 31,593. Treated CAM patients suffer stool difficulties and their medical consumption is relatively high. The EQ-5D, however, shows that the quality of life of CAM patients is only slightly lower than that of the general population (0.88 v 0.93). Treatment results in a gain of 12.7 QALYs. Costs per QALY of treatment for CAM amount to Euro 2,482.


CONCLUSIONS
Treatment for CAM has a favorable cost-effectiveness ratio compared with other evaluated healthcare programs. Bearing in mind the increasing political interest in evidence-based and cost-effective medicine, the results are encouraging.
Poley
M J
MJ
Institute for Medical Technology Assessment (iMTA) and Department of Pediatric Surgery, Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands.
Stolk
E A
EA
Langemeijer
R A
RA
Molenaar
J C
JC
Busschbach
J J
JJ
D001003:Anal Canal / Q000002:abnormalities; D003362:Cost-Benefit Analysis; D006801:Humans; D007231:Infant, Newborn; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D012007:Rectum / Q000002:abnormalities*; D012189:Retrospective Studies; D013520:Urologic Surgical Procedures / Q000191:economics*; D026712:Value of Life / Q000191:economics