Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles School of Medicine.
Plast Reconstr Surg. 2010 Nov;126(5):1652-1664. doi: 10.1097/PRS.0b013e3181ef8e82.
Neonatal upper airway obstruction demands urgent attention. Tracheostomy can prove to be lifesaving but has morbidities. Recently, the authors found reduced morbidity/mortality when using a distraction decision tree model compared with conventional "case-by-case" management. In this current study, the authors assess the long-term costs of (1) a decision tree model versus conventional treatment and (2) tracheostomy versus distraction osteogenesis.
An inpatient cost-matrix analysis study on neonates with upper airway obstruction and micrognathia was performed (n=149). In Part I, conventionally treated neonates managed on a case-by-case basis received home monitoring or a tracheostomy. Decision tree model-managed newborns had specialist consultations and diagnostic testing to determine whether home monitoring, tracheostomy, or distraction osteogenesis would be implemented. In Part II, tracheostomy treatment was compared directly to distraction osteogenesis.
In Part I (conventional versus decision tree model), taking into account the costs of the distraction, tracheostomy, hospital stay, diagnostic studies, physician fees, and emergency department visits, the total per patient treatment cost was 1.5 greater in the conventional treatment group ($332,673) compared with the decision tree model ($225,998) (p<0.05). In Part II (tracheostomy versus distraction osteogenesis), the total per-patient treatment cost in the tracheostomy group was two times greater than in the distraction group ($382,246 versus $193,128) (p<0.05).
In treating newborns with micrognathia and upper airway obstruction, a decision tree model with mandibular distraction decreases long-term health care costs compared with conventional treatment. Furthermore, when comparing distraction to tracheostomy, similar decreases in long-term health care costs occurred.
新生儿上呼吸道梗阻需要紧急关注。气管切开术可能是救命的，但也有发病率。最近，作者发现使用分散决策树模型与传统的“逐个病例”管理相比，发病率/死亡率降低。在本研究中，作者评估了（1）决策树模型与传统治疗以及（2）气管切开术与牵引成骨术的长期成本。
对患有上呼吸道梗阻和小下颌畸形的新生儿进行了住院成本矩阵分析研究（n=149）。在第 I 部分中，根据具体情况对传统治疗的新生儿进行治疗，接受家庭监测或气管切开术。决策树模型管理的新生儿接受专家咨询和诊断性检查，以确定是否进行家庭监测、气管切开术或牵引成骨术。在第 II 部分中，直接比较气管切开术治疗与牵引成骨术。
在第 I 部分（常规治疗与决策树模型）中，考虑到牵引、气管切开术、住院、诊断研究、医生费用和急诊费用，常规治疗组（332673 美元）的每位患者治疗总成本比决策树模型组（225998 美元）高 1.5 美元（p<0.05）。在第 II 部分（气管切开术与牵引成骨术）中，气管切开术组每位患者的治疗总成本是牵引组的两倍（382246 美元比 193128 美元）（p<0.05）。
在治疗患有小下颌畸形和上呼吸道梗阻的新生儿时，与传统治疗相比，下颌骨牵引的分散决策树模型可降低长期医疗保健成本。此外，与气管切开术相比，牵引术也可降低长期医疗保健成本。
