Marten J. Poley - Erasmus Universiteit Rotterdam

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40Chapter 3child's date of birth) at 5% per year. Additionally, we calculated the outcomeapplying a discount rate of 0%.3.3 RESULTSRespondersOf the 285 patients who underwent treatment for CDH, 261 (92%) patients couldbe traced. Eighty-six of these 261 patients (33%) had died, and 7 patients(2.7%) were mentally disabled. The remaining 168 were sent questionnairescontaining questions on social and demographic characteristics, the costs oftreatment (with the exception of the direct medical costs), and its effects (theprevalence of symptoms, the medical consumption, and the overall quality oflife). The response rate was 67% (n = 112). Female patients constituted almosthalf of the responders (46%). The mean age of the responders was 14.8 years(range, 1 to 42). The nonresponders did not differ from the responders in termsof sex or age. The children in the patient group did not differ from theircontemporaries in the general population in regard to participation in education,attending a special school, or educational level. There is no indication that adultpatients differ from the general population in regard to completed education,having a partner, and number of children. Finally, fewer CDH patients were livingalone than population standards predict (significant at the 0.05 level).Questionnaires were sent to (the caregivers of) 72 children belonging to thecontrol group and returned by 53 (74%). These children were aged between 1and 17 years (mean, 7.4 years).CostsDirect medical costs. Table 3.1 presents the costs of the most important unitsthat pertain to the health care costs between the child's birth and the end of thehospital admission during which the defect in the diaphragm was closed (the firstadmission in 95% of the patients). This period lasts, on average, 91 days in thesurvivors (median, 33 days), as against 7 days in the deceased (median, 2 days).Table 3.2 shows that the mean direct medical costs are considerable (€ 33,080;1 Euro = 0.87 US dollar). The distribution of these costs appears to be skew.Fifty-eight percent of the costs are spent on the 21% most expensive patients.The average periods of intensive care and medium care are 24 days (median, 14days) and 4 days (median, 0 days), respectively. The difference between thesurvivors and the deceased (significant at the 0.05 level) and that betweenpatients treated with ECMO and patients not treated with ECMO (not significant atthe 0.05 level) also are shown.Direct nonmedical costs. The transportation costs amount to € 356 up to the ageof 45 years.
Cost-Effectiveness of Treatment for Congenital Diaphragmatic Hernia 41Table 3.1 Costs (in the Year 1998) of Units Pertaining to the Direct Medical Costs of CDHHospital days (86.4% of the total direct medical costs)Medium care € 476Intensive care € 1,036Additional costs of ECMO * € 9,400Laboratory tests † (5.1% of the total direct medical costs)12 tests: mean cost price (SD) ‡ € 2.24 (€ 0.47)Blood gas € 10.35Calcium € 3.11C-reactive protein € 4.90Magnesium € 6.24Cross-reactivity test € 5.22Blood group ABO and Rh factor € 3.24Bacteriological culture € 16.06Postnatal chromosome culture € 499.16Prenatal chromosome culture € 494.62Diagnostic radiology § (3.7% of the total direct medical costs)Echography abdomen € 95.11Echography kidneys and bladder € 79.17Echography heart € 85.94Echography skull € 85.63Abdominal X-ray (1 direction) € 38.09Thoracic X-ray € 34.80X-ray stomach/duodenum/oesophagus (barium swallow) € 100.22Surgeries (4.7% of the total direct medical costs)Hernia repair (using a Gore-Tex patch) € 1,959Central line insertion (Broviac catheter) € 608Nissen fundoplication € 2,046Intercollegial consultations (0.0% of the total direct medical costs)Cardiology € 18.82Neonatology € 25.09Neurology € 25.09Visits to the outpatient department (0.0% of the total direct medical costs)Surgery € 59.53Lung diseases € 96.06Pediatrics € 64.69*†‡§Additional costs of a complete ECMO treatment over the costs of a 'standard' day in anintensive care unit.Tariffs instead of cost prices.Twelve different 'general' tests, such as kalium, glucose, and hemoglobin.Not all interventions can be enumerated here. Some interventions that resemble others arenot mentioned. As in the other categories, this enumeration does not imply that each actionis carried out for each patient.Additional echocardiography not included.Indirect medical costs. We were able to estimate the indirect medical costs onthe basis of the difference between CDH patients and the general population inmedical consumption after the hospital admission during which the defect in the
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Page 6 and 7: DOCTORAL COMMITTEEPromotors:Prof.dr
Page 9 and 10: PUBLICATIONSChapters 2 to 7 are bas
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Page 14 and 15: 2Chapter 11.1 BACKGROUND AND MOTIVA
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Page 18 and 19: 6Chapter 1disability, and death of
Page 21: Introduction 9particular equity pri
Page 25 and 26: Introduction 1320. Oostenbrink JB,
Page 27 and 28: Introduction 1554. Heyman MB, Harma
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Page 48 and 49: 36Chapter 3ABSTRACTBackground/Purpo
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Page 54 and 55: 42Chapter 3diaphragm was closed (Ta
Page 56 and 57: 44Chapter 3Total costs of treatment
Page 58 and 59: 46Chapter 3Regarding the treatment
Page 60 and 61: 48Chapter 3REFERENCES1. Stolk EA, P
Page 62 and 63: 50Chapter 332. Jaillard S, Pierrat
Page 64 and 65: 52Chapter 4ABSTRACTAims:To examine
Page 66 and 67: 54Chapter 4Outcome measuresThe pati
Page 68 and 69: 56Chapter 4Clearly, the symptoms st
Page 70 and 71: 58Chapter 4The respondents did not
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Page 80 and 81: 68Chapter 5ABSTRACTObjective:Extrac
Page 82 and 83: 70Chapter 5treatment. 26,27 Finally
Page 84 and 85: 72Chapter 5CostsOnly direct costs w
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Page 88 and 89: 76Chapter 5Table 5.3 Direct Medical
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Page 92 and 93: 80Chapter 5severely ill newborns—
Page 94 and 95: 82Chapter 5REFERENCES1. Bartlett RH
Page 96 and 97: 84Chapter 533. Meinert CL: Extracor
Page 98 and 99: 86Chapter 568. Hui TT, Danielson PD
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90Chapter 6a rule. The health-relat
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92Chapter 6Regression analysis of h
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94Chapter 6that caregiving for thei
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96Chapter 6Table 6.5 CareQol Compar
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98Chapter 6children with a disabili
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100Chapter 6This study was of impor
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102Chapter 618. Poley MJ, Stolk EA,
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104Chapter 654. Boman KK, Viksten J
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106Chapter 7ABSTRACTMortality rates
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108Chapter 77.2 THE RELEVANCE OF CO
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110Chapter 7In the early 2000s, our
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112Chapter 7Table 7.1 Economic Eval
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114Chapter 7More from a policy pers
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116Chapter 7also expect that life-s
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118Chapter 7entirely justified, for
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120Chapter 723. Sydorak RM, Nijagal
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122Chapter 765. Glaser AW, Davies K
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GENERAL DISCUSSION:A GUIDED TOURPRO
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General Discussion: A Guided Tour P
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142GlossaryCharge (or: tariff)A pri
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144Glossaryefficient one. We are th
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SUMMARY
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Summary 149mortality. Finally, it i
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Summary 151neonatal surgery. It is
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SAMENVATTING
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Samenvatting 155zoals directe niet-
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Samenvatting 157Hoofdstuk 6 gaat ve
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Samenvatting 159vereisen, waarvoor
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162AcknowledgmentsAlthough I am ind
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About the AuthorBorn in De Meern (N
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Marten J. Poley - Erasmus Universiteit Rotterdam

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