The cost-effectiveness of treatment for congenital diaphragmatic hernia.
OBJECTIVE
The cost-effectiveness of medical interventions is becoming an important issue for decision makers. Until recently, evidence of the cost-effectiveness of neonatal surgery was largely lacking. The authors analyzed the cost-effectiveness of neonatal surgery and subsequent treatment for congenital diaphragmatic hernia (CDH).


METHODS
Both costs incurred inside and outside the health care sector (eg, out-of-pocket expenses and productivity losses) were included. 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. Both costs and effects basically were measured in a life-time setting.


RESULTS
Total costs of treatment average euro 42,658, mainly consisting of costs of the initial hospitalization. Productivity losses in both the patients and their caregivers appear to be minor. Treated CDH patients, even adults, suffer from respiratory difficulties and stomach aches. According to the EQ-5D, however, their quality of life does not differ from the general population, suggesting that these symptoms barely affect overall quality of life. Treatment results in a gain of 17.5 QALYs. Costs per QALY amount to euro 2,434.


CONCLUSIONS
Treatment for CDH has favorable cost-effectiveness. Considering the growing importance of cost-effective medicine, these are important and encouraging results. Health economics outlines the inevitability of making choices that directly affect patient care and places relative values on different health care programs. The results of this study provide convincing evidence that treatment for CDH is indeed cost effective.
Poley
Marten J
MJ
institute for Medical Technology Assessment (iMTA) and the Department of Pediatric Surgery, Sophia Children's Hospital, University Hospital Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Stolk
Elly A
EA
Tibboel
Dick
D
Molenaar
Jan C
JC
Busschbach
Jan J v
JJ
D004180:Direct Service Costs / Q000706:statistics & numerical data; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006548:Hernia, Diaphragmatic / Q000191:economics* / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires