Marten J. Poley - Erasmus Universiteit Rotterdam

Cost-Effectiveness of Treatment for Congenital Diaphragmatic Hernia 39laboratory tests, diagnostic radiology, surgeries, intercollegial consultations, andvisits to the outpatient department. There is, however, one difference with ourprevious study. Costs of ECMO were calculated as part of the direct medical costs.These costs, i.e., the additional costs over the costs of a 'standard' day in anintensive care unit, were taken from a large Dutch survey on ECMO in neonates. 14Direct nonmedical costs are costs incurred outside the health care sector thataccrue to patients and their families while receiving health care. These costs werelimited to transportation costs regarding visits to health care providers.Indirect medical costs are the health care costs made after the period that refersto the direct medical costs. Costs of hospital admissions, visits to the outpatientdepartment, consultations with a general practitioner, and consultations with aphysiotherapist are all part of these costs. No reliable data were available oncosts of visits to alternative healers, use of medication outside the hospital, anduse of medicinal oxygen at home. We excluded future health care costs ofunrelated diseases.Indirect nonmedical costs are costs associated with production loss andreplacement owing to illness, disability, and death of productive persons, bothpaid and unpaid. 15 As we adopted a societal perspective, both productivitychanges in patients and in their parents or caregivers were included.EffectsIdentification, measurement, and valuation of the effects. We repeated themethodology outlined in the previous chapter regarding the effects. 4 In summary,we calculated both the life expectancy and the health-related quality of life. Weassumed that patients who survived the first few years would have a normal lifeexpectancy (75.4 years at birth 16 ). The life span of the deceased patients alsowas determined. On the basis of these data, the mean life expectancy wascalculated. Using the EQ-5D questionnaire, 17 we were then able to calculate theQALY gains. Descriptive quality-of-life data were collected using a disease-specificquestionnaire that aimed to measure respiratory difficulties, stomach aches, andother disease-specific symptoms. A symptom score of the most relevant clinicalitems was constructed, ranging from 0 to 45 (maximum number of symptoms).Medical consumption also was considered an indication of the quality of life.Generally, patients younger than 16 years did not fill in the questionnairesthemselves. Their parents were used as proxies. The disease-specificquestionnaire was the only exception. Here, the age limit was put at 12 years.Cost-effectivenessIncremental costs per QALY of treatment for CDH compared with 'no treatment'were calculated. Both future costs and future effects were discounted (to the