title: Economic advantages to a distraction decision tree model for management of neonatal upper airway obstruction.
abstract: BACKGROUND
  Neonatal upper airway obstruction demands urgent attention. Tracheostomy can prove to be lifesaving but has morbidities. Recently, the authors found reduced morbidity/mortality when using a distraction decision tree model compared with conventional "case-by-case" management. In this current study, the authors assess the long-term costs of (1) a decision tree model versus conventional treatment and (2) tracheostomy versus distraction osteogenesis.
  
  
  METHODS
  An inpatient cost-matrix analysis study on neonates with upper airway obstruction and micrognathia was performed (n=149). In Part I, conventionally treated neonates managed on a case-by-case basis received home monitoring or a tracheostomy. Decision tree model-managed newborns had specialist consultations and diagnostic testing to determine whether home monitoring, tracheostomy, or distraction osteogenesis would be implemented. In Part II, tracheostomy treatment was compared directly to distraction osteogenesis.
  
  
  RESULTS
  In Part I (conventional versus decision tree model), taking into account the costs of the distraction, tracheostomy, hospital stay, diagnostic studies, physician fees, and emergency department visits, the total per patient treatment cost was 1.5 greater in the conventional treatment group ($332,673) compared with the decision tree model ($225,998) (p<0.05). In Part II (tracheostomy versus distraction osteogenesis), the total per-patient treatment cost in the tracheostomy group was two times greater than in the distraction group ($382,246 versus $193,128) (p<0.05).
  
  
  CONCLUSIONS
  In treating newborns with micrognathia and upper airway obstruction, a decision tree model with mandibular distraction decreases long-term health care costs compared with conventional treatment. Furthermore, when comparing distraction to tracheostomy, similar decreases in long-term health care costs occurred.
authors.affiliation: Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles School of Medicine.
authors.forename: Emil
authors.initials: E
authors.lastname: Kohan
authors.forename: Salar
authors.initials: S
authors.lastname: Hazany
authors.forename: Jason
authors.initials: J
authors.lastname: Roostaeian
authors.forename: Karam
authors.initials: K
authors.lastname: Allam
authors.forename: Christian
authors.initials: C
authors.lastname: Head
authors.forename: Samuel
authors.initials: S
authors.lastname: Wald
authors.forename: Raj
authors.initials: R
authors.lastname: Vyas
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000402:Airway Obstruction / Q000191:economics* / Q000601:surgery*; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D006801:Humans; D007231:Infant, Newborn; D008844:Micrognathism / Q000191:economics* / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000191:economics; D014139:Tracheostomy / Q000191:economics