Marten J. Poley - Erasmus Universiteit Rotterdam

Cost-Effectiveness of Treatment for Congenital Diaphragmatic Hernia 47not completely similar to the survivors in Muratore's study. Of all survivingpatients in Muratore's study, 29% underwent ECMO treatment, which exceeds theproportion in our study (8%; 2 of 24). Because ECMO survivors are more likely torequire supplementary oxygen at discharge than survivors that did not haveECMO (as Muratore observed), possibly an even smaller proportion than 16% ofour survivors was oxygen dependent at hospital discharge. It must not beconsidered a great limitation that these 2 cost categories had to be ignored.In the discussion section of our ARM study (Chapter 2) we reflected on severalissues regarding the calculation of the effects of treatments. Our remarks on theresponse rate, the parents rating the quality of life of the young children, and theinfluence on the caregivers' quality of life are relevant to this study too and willnot be repeated here. One issue, however, deserves attention. The differences inthe prevalence of disease-specific symptoms between the CDH patients and thegeneral population seem to be underestimated. The children in the control groupsuffer respiratory difficulties and stomach aches to such an extent that it isdoubtful whether this group is representative of the general population. Probably,excluding CDH patients from the control group did not suffice. It is thereforerecommended that, in the future, these data are collected, for example, inprimary schools, instead of in children that visited the hospital's daycaredepartment for minor day-case surgery.It is evident that treatment for CDH has a favorable cost-effectiveness ratio.Considering the growing importance of cost-effective medicine, these areimportant and encouraging results. Health economics outlines the inevitability ofmaking choices that directly affect patient care and places relative values ondifferent health care programs. The results of this study provide convincingevidence that treatment for CDH is indeed cost effective.ACKNOWLEDGMENTSThe authors thank W.B.F. Brouwer, L.A. van Dam, M.A. Koopmanschap, J.B. Oostenbrink, H.A.Post, and R.J.E. van Staveren for their helpful suggestions and discussion during thepreparation of this manuscript; R. Rabin for editing the manuscript; and F.W.J. Hazebroek forhis continuous interest.