Marten J. Poley - Erasmus Universiteit Rotterdam

Cost-Effectiveness of Neonatal Surgery: First Skepticized, Now Increasingly Accepted113Studyno.Country oforigin Alternatives studiedTimehorizonPrimary analysis results, expressed as difference from thecomparatorOther diagnosesSuspectedcraniosynostosisIntervention Comparator Costs Effects Cost-effectiveness ratio91 USA 3 diagnostic strategies compared witheach other: 1) no imaging, 2)radiography (if abnormal, followed by3D CT), 3) 3D CT20 years In low-risk infants, the imaging strategies (strategies 2 and 3)resulted in cost per QALY of more than US$ 560,000. Inintermediate-risk infants, strategy 2 had a cost per QALY ofUS$ 54,600. In high-risk infants, strategy 3 was most effective witha cost per QALY of US$ 33,800 †(Suspected)hypertrophic pyloricstenosisNeonatalcircumcision92USA Volumetricmeasurement ofnasogastric aspiratefor selection ofimaging study93 USA Standardized feedingprotocol94 USA Ad libitum feedingprotocolUltrasonographyas the firststudyVariablefeedingprotocolsConventionalregimentedprotocol95 USA Neonatal circumcision NotcircumcisingInitial hospitalcareA few weeksafter initialhospital careNot exactlyclear- US$ 50 ‡ No difference § Needed not be calculated,because the intervention wasboth less costly and equallyeffective- 11.9% No significantdifference incomplication rate- US$ 1,270 Higher rate ofsignificant emesis(32% v 26%)Life-time +US$ 828 + 0.0153 well-yearslostNeeded not be calculated,because the intervention wasboth less costly and equallyeffectiveNot calculatedNeeded not be calculated,because the intervention wasboth more costly and lesseffectiveStudy no. refers to references. Abbreviation: 3D CT, three-dimensional computed tomography.Original research (excluding reviews) published in English from 1999 through January 2005. We conformed to the following definition of a completeeconomic evaluation: 'the comparative analysis of alternative courses of action in terms of both their costs and consequences'. 3 Any outcome measurewas accepted, and no quality requirements for the studies were set.Database searched: PubMed (http://www.ncbi.nlm.nih.gov/entrez). We searched no other literature databases for economic evaluations, because thiswas expected to be of little additional value—as Sassi and colleagues demonstrated. 96*†‡§These studies also included other diagnostic categories than congenital diaphragmatic hernia and did not present separate cost-effectiveness ratios.The authors present incremental cost-effectiveness ratios for the three different strategies, separately for three risk groups (completely healthychildren, healthy children with head deformity, and children with syndromic craniofacial disorders). Not all cost-effectiveness ratios calculated by theauthors can be duplicated here.Or, as reported by the authors: at least US$ 4,464 and 30 hours of physician time in the total group of 89 infants.Both alternative strategies would correctly detect all cases.