title: Cost-effectiveness of infant orthopedic treatment regarding speech in patients with complete unilateral cleft lip and palate: a randomized three-center trial in the Netherlands (Dutchcleft).
abstract: OBJECTIVE
  To investigate the cost-effectiveness of infant orthopedic treatment (IO), compared with no such treatment in children with complete unilateral cleft lip and palate (UCLP) focusing on the effects on speech development at age 2.5 years.
  
  
  METHODS
  In a three-center prospective, randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally: one group was treated with IO based on a modified Zurich approach in the first year of life (IO group) and the other group did not receive this treatment (non-IO group).
  
  
  METHODS
  The participants had complete UCLP without soft tissue bands or other malformations. They were born at term and their parents were native Dutch speakers.
  
  
  METHODS
  The effect of IO on speech development at age 2.5 years was measured blindly by five expert listeners judging the "total impression of speech quality" on a 10-point equal-appearing interval scale. Costs were measured from a societal viewpoint in Euro.
  
  
  CONCLUSIONS
  The IO group (n = 10) obtained a statistically significant higher rating, compared with the non-IO group (n = 10). The effect size was large, indicating that the improvement may be considered a clinically important change. The cost for treatment by the orthodontist was higher in the IO group. For both groups, the mean cost was related to the mean rating for "total impression of speech quality." The resulting cost-effectiveness for IO, compared to non-IO was 1041 for 1.34 point speech quality improvement. The financial investment that is necessary to obtain this improvement seems limited. Thus, from the perspective of speech development, the cost-effectiveness of IO over non-IO seems acceptable at this point in time.
authors.affiliation: Department of Orthodontics and Oral Biology, University Medical Centre St. Radboud, University of Nijmegen, The Netherlands. e.konst@dent.umcn.nl
authors.forename: Emmy M
authors.initials: EM
authors.lastname: Konst
authors.forename: Charlotte
authors.initials: C
authors.lastname: Prahl
authors.forename: Hanny
authors.initials: H
authors.lastname: Weersink-Braks
authors.forename: Theo
authors.initials: T
authors.lastname: De Boo
authors.forename: Birte
authors.initials: B
authors.lastname: Prahl-Andersen
authors.forename: Anne M
authors.initials: AM
authors.lastname: Kuijpers-Jagtman
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
mesh_terms: D002675:Child, Preschool; D002971:Cleft Lip / Q000150:complications; D002972:Cleft Palate / Q000150:complications*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D009972:Orthodontics, Interceptive / Q000191:economics* / Q000295:instrumentation; D010158:Palatal Obturators / Q000191:economics*; D011446:Prospective Studies; D013064:Speech Disorders / Q000209:etiology / Q000517:prevention & control*; D013068:Speech Production Measurement; D014833:Voice Quality