Shay Paul L, Goldstein Jesse A, Paliga J Thomas, Wink Jason, Jackson Oksana A, Low David, Bartlett Scott P, Taylor Jesse A
Philadelphia, Pa. From the Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia.
Plast Reconstr Surg. 2015 Dec;136(6):1264-1271. doi: 10.1097/PRS.0b013e31829b69fe.
Patients with complete cleft lip and palate may benefit from cleft lip adhesion or nasoalveolar molding before formal cleft lip repair. The authors compared the relative costs to insurers of these two treatment modalities and the burden of care to families.
A retrospective analysis was performed of cleft lip and palate patients treated with nasoalveolar molding or cleft lip adhesion at The Children's Hospital of Philadelphia between January of 2007 and June of 2012. Demographic, appointment, and surgical data were reviewed; surgical, inpatient hospital, and orthodontic charges and costs were obtained. Multivariate linear regression and two-sample, two-tailed independent t tests were performed to compare cost and appointment data between groups.
Forty-two cleft adhesion and 35 nasoalveolar molding patients met inclusion criteria. Mean costs for nasoalveolar molding were $3550.24 ± $667.27. Cleft adhesion costs, consisting of both hospital and surgical costs, were $9370.55 ± $1691.79. Analysis of log costs demonstrated a significant difference between the groups, with the mean total cost for nasoalveolar molding significantly lower than that for adhesion (p < 0.0001). Nasoalveolar molding patients had significantly more made, cancelled, no-show, and missed visits and a higher missed percentage than adhesion patients (p < 0.0001) for all except no-show appointments, (p = 0.0199), indicating a higher burden of care to families.
Nasoalveolar molding may cost less before formal cleft lip repair treatment than cleft lip adhesion. Third-party payers who cover adhesion and not nasoalveolar molding may not be acting in their own best interest. Nasoalveolar molding places a higher burden of care on families, and this fact should be considered in planning treatment.
完全性唇腭裂患者在正式唇裂修复前可能从唇粘连术或鼻牙槽塑形术中获益。作者比较了这两种治疗方式对保险公司的相对成本以及家庭的护理负担。
对2007年1月至2012年6月在费城儿童医院接受鼻牙槽塑形术或唇粘连术治疗的唇腭裂患者进行回顾性分析。审查人口统计学、预约和手术数据；获取手术、住院和正畸费用。进行多变量线性回归和双样本、双尾独立t检验以比较组间成本和预约数据。
42例唇粘连术患者和35例鼻牙槽塑形术患者符合纳入标准。鼻牙槽塑形术的平均成本为3550.24美元±667.27美元。唇粘连术的成本，包括医院和手术成本，为9370.55美元±1691.79美元。对数成本分析显示两组之间存在显著差异，鼻牙槽塑形术的平均总成本显著低于唇粘连术（p<0.0001）。除无故未就诊预约外（p=0.0199），鼻牙槽塑形术患者的已预约、取消、无故未就诊和错过就诊次数显著多于唇粘连术患者，且错过百分比更高（p<0.0001），表明家庭的护理负担更重。
在正式唇裂修复治疗前，鼻牙槽塑形术的成本可能低于唇粘连术。承保唇粘连术但不承保鼻牙槽塑形术的第三方支付方可能并非出于自身最佳利益行事。鼻牙槽塑形术给家庭带来更高的护理负担，在规划治疗时应考虑这一事实。
