Cost-Effectiveness Analysis of the Surgical Management of Infants Less than One Year of Age with Feeding Difficulties
| Autor: | Eric H. Chiou, Monica E. Lopez, Panagiotis Kougias, David E. Wesson, Megan E. Cunningham, Annalyn S. DeMello, Yangyang R. Yu, Mary L. Brandt |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Reoperation Pediatrics medicine.medical_specialty Office Visits Visual analogue scale Cost effectiveness Cost-Benefit Analysis medicine.medical_treatment Gastric Bypass Fundoplication Patient Readmission Severity of Illness Index Feeding difficulty Feeding and Eating Disorders 03 medical and health sciences Enteral Nutrition 0302 clinical medicine Quality of life Surveys and Questionnaires 030225 pediatrics Humans Medicine Intubation Gastrointestinal Retrospective Studies Gastrostomy business.industry Infant General Medicine Cost-effectiveness analysis medicine.disease 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health Gastroesophageal Reflux Quality of Life GERD Female Surgery Emergency Service Hospital business Resource utilization Follow-Up Studies |
| Zdroj: | Journal of Pediatric Surgery. 55:187-193 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2019.09.076 |
| Popis: | We compared the cost-effectiveness of the common surgical strategies for the management of infants with feeding difficulty.Infants with feeding difficulty undergoing gastrostomy alone (GT), GT and fundoplication, or gastrojejunostomy (GJ) tube were enrolled between 2/2017 and 2/2018. A validated GERD symptom severity questionnaire (GSQ) and visual analog scale (VAS) to assess quality of life (QOL) were administered at baseline, 1 month, and every 6 months. Data collected included demographics, resource utilization, diagnostic studies, and costs. VAS scores were converted to quality adjusted life months (QALMs), and costs per QALM were compared using a decision tree model.Fifty patients initially had a GT alone (71% laparoscopically), and one had a primary GJ. Median age was 4 months (IQR 3-8 months). Median follow-up was 11 months (IQR 5-13 months). Forty-three did well with GT alone. Six (12%) required conversion from GT to GJ tube, and one required a fundoplication. Of those with GT alone, six (14%) improved significantly so that their GT was removed after a mean of 7 ± 3 months. Overall, the median GSQ score improved from 173 at baseline to 18 after 1 year (p 0.001). VAS scores also improved from 70/100 at baseline to 85/100 at 1 year (p 0.001). ED visits (59%), readmissions (47%), and clinic visits (88%) cost $58,091, $1,442,139, and $216,739, respectively. GJ tube had significantly higher costs for diagnostic testing compared to GT (median $8768 vs. $1007, p 0.001). Conversion to GJ tube resulted in costs of $68,241 per QALM gained compared to GT only.Most patients improved with GT alone without needing GJ tube or fundoplication. GT and GJ tube were associated with improvement in symptoms and QOL. GJ tube patients reported greater gains in QALMS but incurred higher costs. Further analysis of willingness to pay for each additional QALM will help determine the value of care.Cost-effectiveness study, Level II. |
| Databáze: | OpenAIRE |
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