美国先天性膈疝修复的成本-体外膜氧合承担费用。

Costs of congenital diaphragmatic hernia repair in the United States-extracorporeal membrane oxygenation foots the bill.

机构信息

Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL 60611, USA; Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Children's Memorial Hospital, Chicago, IL 60614, USA.

Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL 60611, USA.

出版信息

J Pediatr Surg. 2011 Apr;46(4):617-624. doi: 10.1016/j.jpedsurg.2010.09.047.

DOI:10.1016/j.jpedsurg.2010.09.047

PMID:21496527

Abstract

BACKGROUND

Congenital diaphragmatic hernia (CDH) is the costliest noncardiac congenital defect. Extracorporeal membrane oxygenation (ECMO) is a treatment strategy offered to those babies with CDH who would not otherwise survive on conventional therapy. The primary objective of our study was to identify the leading source of expenditures in CDH care.

METHODS

All patients surviving CDH repair were identified in the Kids' Inpatient Database (KID) from 1997 to 2006, with costs converted to 2006 US dollars. Patients were categorized into groups based on severity of disease for comparison including CDH repair only, prolonged ventilator dependence, and ECMO use. Factors associated with greater expenditures in CDH management were analyzed using a regression model.

RESULTS

Eight hundred thirty-nine patients from 213 hospitals were studied. Extracorporeal membrane oxygenation use decreased from 18.2% in 1997 to 11.4% in 2006 (P = .002). Congenital diaphragmatic hernia survivors managed with ECMO cost more than 2.4 times as much as CDH survivors requiring only prolonged ventilation postrepair and 3.5 times as much as those with CDH repair only (both P < .001). Age, multiplicity of diagnoses, patient transfer, inhaled nitric oxide use, prolonged ventilation, and ECMO use were all associated with higher costs. Extracorporeal membrane oxygenation use was the single most important factor associated with higher costs, increasing expenditures 2.4-fold (95% confidence interval, 2.1-2.8). Though the CDH repair with ECMO group constituted 12.2% of patients, this group has the highest median costs ($156,499.90/patient) and constitutes 28.5% of national costs based on CDH survivors in the KID. Annual national cost for CDH survivors is $158 million based on the KID, and projected burden for all CDH patients exceeds $250 million/year.

CONCLUSIONS

Extracorporeal membrane oxygenation use is the largest contributing factor to the economic burden in CDH. With limited health care resources, judicious resource utilization in CDH care merits further study.

摘要

背景

先天性膈疝（CDH）是最昂贵的非心脏先天性缺陷。体外膜氧合（ECMO）是为那些在常规治疗下无法存活的 CDH 婴儿提供的治疗策略。我们研究的主要目的是确定 CDH 护理费用的主要来源。

方法

从 1997 年到 2006 年，在儿童住院数据库（KID）中确定了所有存活的 CDH 修复患者，并将成本转换为 2006 年的美元。根据疾病严重程度将患者分为不同组别进行比较，包括仅进行 CDH 修复、延长呼吸机依赖和 ECMO 使用。使用回归模型分析与 CDH 管理费用较高相关的因素。

结果

来自 213 家医院的 839 名患者参与了研究。ECMO 使用从 1997 年的 18.2%下降到 2006 年的 11.4%（P=0.002）。需要 ECMO 治疗的 CDH 幸存者的费用是仅需要延长通气后修复的 CDH 幸存者的 2.4 倍以上，是仅进行 CDH 修复的幸存者的 3.5 倍以上（均 P<0.001）。年龄、多种诊断、患者转院、吸入一氧化氮使用、延长通气和 ECMO 使用均与更高的费用相关。ECMO 使用是与更高费用相关的唯一最重要因素，使支出增加 2.4 倍（95%置信区间，2.1-2.8）。尽管 CDH 修复加 ECMO 组占患者的 12.2%，但该组的中位费用最高（$156499.90/患者），并占 KID 中 CDH 幸存者的 28.5%的全国费用。根据 KID，CDH 幸存者的年全国费用为 1.58 亿美元，预计所有 CDH 患者的负担超过每年 2.5 亿美元。