Marten J. Poley - Erasmus Universiteit Rotterdam

36Chapter 3ABSTRACTBackground/Purpose:The cost-effectiveness of medical interventions is becoming animportant issue for decision makers. Until recently, evidenceof the cost-effectiveness of neonatal surgery was largelylacking. We analyzed the cost-effectiveness of neonatalsurgery and subsequent treatment for congenitaldiaphragmatic hernia (CDH).Methods:Both costs incurred inside and outside the health care sector(e.g., out-of-pocket expenses and productivity losses) wereincluded. Quality-adjusted life years (QALYs) were measuredusing the EuroQol EQ-5D questionnaire. Descriptive quality-oflifedata were collected using a disease-specific questionnaire.Both costs and effects basically were measured in a life-timesetting.Results:Total costs of treatment average € 42,658, mainly consistingof costs of the initial hospitalization. Productivity losses in boththe patients and their caregivers appear to be minor. TreatedCDH patients, even adults, suffer from respiratory difficultiesand stomach aches. According to the EQ-5D, however, theirquality of life does not differ from the general population,suggesting that these symptoms barely affect overall qualityof life. Treatment results in a gain of 17.5 QALYs. Costs perQALY amount to € 2,434.Conclusions:Treatment for CDH has favorable cost-effectiveness.Considering the growing importance of cost-effectivemedicine, these are important and encouraging results. Healtheconomics outlines the inevitability of making choices thatdirectly affect patient care and places relative values ondifferent health care programs. The results of this studyprovide convincing evidence that treatment for CDH is indeedcost effective.