Marten J. Poley - Erasmus Universiteit Rotterdam

Cost-Effectiveness of Treatment for Congenital Anorectal Malformations 27Table 2.5 Productivity Losses in the Parents/Caregivers of 115 ARM PatientsFemaleCaregiversMaleCaregivers *Paid workCaregivers having paid work 49% † 96% ‡TotalPer ChildMean number of hours paid work per week 9.7 § 39.0Caregivers who gave up paid work for taking care of 45% 2%their child(-ren)Mean number of hours paid work given up per week 11.6 0.3for taking care of their child(-ren)Caregivers who gave up paid work for taking care of 12% 1%their child(-ren) as a consequence of the ARMMean number of hours paid work given up per week 2.4 0.2for taking care of their child(-ren) as aconsequence of the ARMProductivity losses during the friction period € 401 € 30 € 420Unpaid work Mean number of hours spent on unpaid work perweekMean number of hours less to spend on unpaid workper week as a consequence of the ARM andtaking careProductivity losses during one year after the child'sbirth29.3 10.21.4 1.1€ 565 € 445 € 957Total productivity losses € 1,377*†‡§One percent of these caregivers is female. Children of these caregivers have two femalecaregivers.Only in caregivers aged from 25 to 34 significantly lower than in the general population(P = 0.003).In no age class different from the general population at the 0.05 level.As in all following numbers in this table: this is the mean of all (female or male) caregivers,thus including those who do not have paid work, did not give up paid work, etc.Household work, shopping, and odd jobs.Cost-effectiveness and sensitivity analysisCosts per QALY for the treatment of ARM compared with 'no treatment' amount to€ 2,482 (€ 1,082 without discounting). Finally, we performed a sensitivityanalysis to determine to what extent our assumption on the patients' quality oflife in the 'no treatment' scenario (0.5) influenced these results. Values between0.6 and 0.4 are seen as a plausible range (0.5 ± 20%). This results in a moreconservative estimate of € 2,696 costs per QALY and a less conservative estimateof € 2,300 costs per QALY (both discounted).2.4 DISCUSSIONWe analyzed the cost-effectiveness of treatment for ARM. The costs appear to besubstantial, especially the direct medical costs. Considerable stool difficulties