Marten J. Poley - Erasmus Universiteit Rotterdam

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74Chapter 5summarized in Table 5.2. Compared with the historical group, patients in theECMO group more often were male and more often were delivered by caesariansection, but pregnancy complications occurred less frequently (both diagnosisgroups taken together). These differences however, did not reach statisticalsignificance. Labor and delivery complications were also less common in theECMO group (P = 0.02). The length of ECMO runs remained rather unchangedduring the study period. When all ECMO patients are divided into three groupsaccording to date of birth, the ECMO run time averages 7.4 days in the earliestgroup (n = 82), as opposed to 8.3 days in the middle group (n = 81) and 8.0 inthe last group (n = 81) (ANOVA F-test, P = 0.31). The total length of the initialhospitalization was 53 days on average in the ECMO-treated CDH patients(median, 45 days; skewness, 1.9), as against 37 days in the patients with MAS(median, 32 days; skewness, 3.5)—the difference being significant (P < 0.001).According to Rosner's test for multiple outliers, the CDH group contained onestatistical outlier (hospitalized for 273 days), while there were four outliers in theMAS group (191, 161, 153, and 97 days respectively).Comparison of the survival probability for the separate diagnostic categories withthe model developed by Toomasian et al. revealed that the ECMO patients andthe control patients had a similar outlook. In the patients with CDH, the survivalprobability amounted to 0.62 both in the ECMO group and the control group(P = 0.93). In the MAS patients, the predicted survival rate was 0.79 in the ECMOgroup, as opposed to 0.80 in the control group (P = 0.82). Furthermore, we foundno evidence of a statistically significant difference in predicted survival betweenthe total ECMO group and the total control group (0.72 v 0.70; P = 0.36).CostsWe first investigated whether the patients who were the subjects of the costanalysis were sufficiently similar to the other ECMO patients. The mean predictedsurvival (as expressed by the model of Toomasian et al.) in the subgroup was notsignificantly deviant from the other patients (0.75 v 0.72; P = 0.10). Neither didwe find statistically significant differences between the patients being part of thecost study and the other patients in mean duration of ECMO (7.1 v 8.2 days;P = 0.06) and total length of stay (42 v 44 days; P = 0.66).Overall costs of treatment including ECMO amounted to € 38,553 per patient(Table 5.3), approximately equivalent to 44,000 US dollars (2003). Half of thecosts are due to costs for diagnostic tests and costs of personnel, withapproximately half of the latter incurred in the period that the patient is on ECMO.Mean costs for treatment of a patient with CDH (€ 50,792) were considerablyhigher than for a patient with MAS (€ 29,472). This difference is mainly caused bythe fact that the hospitalization period of neonates with CDH was 18 days longer,on average, than that of the MAS patients.
Cost-Effectiveness of Neonatal Extracorporeal Membrane Oxygenation in the Netherlands 75Table 5.2 Clinical and Demographic Characteristics of ECMO and Control PatientsECMOControlsP valueCharacteristicSex (% male)Gestational age (wk)Birth weight (kg)Caesarian delivery (%)Pregnancy complications * (%)Labor and delivery complications † (%)1-minute Apgar score5-minute Apgar scoreBorn in hospital (%)Born in ECMO center (%) ‡Prenatal diagnosis (%)Last pre-ECMO pHRenal insufficiency § (%)CDH(n = 100)6338.9 ± 2.03.1 ± 0.51818284.5 ± 2.25.8 ± 1.88837367.26 ± .138MAS(n = 144)5440.3 ± 1.43.5 ± 0.63814274.4 ± 2.46.1 ± 2.1905NA7.35 ± .152Total(n = 244)5839.7 ± 1.83.3 ± 0.63015274.4 ± 2.46.0 ± 2.08918NA7.31 ± .155CDH(n = 24)5839.4 ± 1.63.1 ± 0.4830304.8 ± 2.85.8 ± 2.292NA297.25 ± .155MAS(n = 22)3640.5 ± 1.53.4 ± 0.52419624.6 ± 2.66.2 ± 1.981NANA7.39 ± .139Total(n = 46)4839.9 ± 1.63.2 ± 0.51625454.7 ± 2.76.0 ± 2.087NANA7.31 ± .167CDH0.670.270.800.250.170.780.650.990.59NA0.510.870.57MAS0.120.650.450.220.510.0010.660.790.25NANA0.200.07Total0.210.570.240.050.120.020.510.930.67NANA0.890.51*†‡§Continuous variables expressed by means ± SD. Abbreviations: NA, not applicable.One or more of the following: use of drugs, ovulation induction/artificial insemination by donor/in vitro fertilization, preexisting diabetes, gestationaldiabetes, preexisting hypertension, hypertension in pregnancy, epilepsy, intrauterine growth retardation, other complications.One or more of the following: use of labor-inhibiting drugs (>1 day), post-term pregnancy, induced labor, prolonged membrane rupture (>24 hrs),maternal fever, other complications.Proportion of all patients that were born in a hospital.Either creatinine > 1.5 mg/dl or patient on hemodialysis, hemofiltration, or continuous arterio-venous hemodiafiltration (CAVHD).
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COST-EFFECTIVENESS OF NEONATAL SURG
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DOCTORAL COMMITTEEPromotors:Prof.dr
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PUBLICATIONSChapters 2 to 7 are bas
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6ChapterINFORMAL CARE FOR CHILDREN
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2Chapter 11.1 BACKGROUND AND MOTIVA
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4Chapter 1provides a good overview
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6Chapter 1disability, and death of
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Introduction 9particular equity pri
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Introduction 1320. Oostenbrink JB,
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Introduction 1554. Heyman MB, Harma
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THE COST-EFFECTIVENESS OFTREATMENT
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Cost-Effectiveness of Treatment for
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Page 52 and 53: 40Chapter 3child's date of birth) a
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
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Page 68 and 69: 56Chapter 4Clearly, the symptoms st
Page 70 and 71: 58Chapter 4The respondents did not
Page 72 and 73: 60Chapter 4Table 4.4TAIQOL Scores o
Page 74 and 75: 62Chapter 44.4 DISCUSSIONIn this pa
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Page 82 and 83: 70Chapter 5treatment. 26,27 Finally
Page 84 and 85: 72Chapter 5CostsOnly direct costs w
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
Page 100 and 101: 88Chapter 6ABSTRACTObjective:To inv
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Page 106 and 107: 94Chapter 6that caregiving for thei
Page 108 and 109: 96Chapter 6Table 6.5 CareQol Compar
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Page 112 and 113: 100Chapter 6This study was of impor
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Page 116 and 117: 104Chapter 654. Boman KK, Viksten J
Page 118 and 119: 106Chapter 7ABSTRACTMortality rates
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Page 132 and 133: 120Chapter 723. Sydorak RM, Nijagal
Page 134 and 135: 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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