Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
J Pediatr Surg. 2020 Jan;55(1):187-193. doi: 10.1016/j.jpedsurg.2019.09.076. Epub 2019 Oct 25.
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.
我们比较了治疗喂养困难婴儿的常见手术策略的成本效益。
2017 年 2 月至 2018 年 2 月期间，我们招募了接受单纯胃造口术（GT）、GT 加胃底折叠术或胃空肠造口术（GJ）管治疗的喂养困难婴儿。在基线、1 个月和每 6 个月时，使用经过验证的 GERD 症状严重程度问卷（GSQ）和视觉模拟量表（VAS）评估生活质量（QOL）。收集的数据包括人口统计学资料、资源利用情况、诊断研究和费用。VAS 评分转换为质量调整生命月（QALM），并使用决策树模型比较每个 QALM 的成本。
最初有 50 名患者接受了单纯 GT（71%为腹腔镜手术），1 名患者接受了原发性 GJ。中位年龄为 4 个月（IQR 3-8 个月）。中位随访时间为 11 个月（IQR 5-13 个月）。43 名患者 GT 治疗效果良好。6 名（12%）需要从 GT 转为 GJ 管，1 名需要胃底折叠术。在单纯 GT 的患者中，有 6 名（14%）的患者明显改善，他们的 GT 在平均 7±3 个月后被移除。总的来说，GSQ 评分从基线时的 173 分降至 1 年后的 18 分（p<0.001）。VAS 评分也从基线时的 70/100 分提高到 1 年后的 85/100 分（p<0.001）。急诊就诊（59%）、再入院（47%）和门诊就诊（88%）的费用分别为 58091 美元、1442139 美元和 216739 美元。与 GT 相比，GJ 管的诊断性检查费用明显更高（中位数 8768 美元比 1007 美元，p<0.001）。与单纯 GT 相比，转为 GJ 管的成本为每获得 1 个 QALM 增加 68241 美元。
大多数患者单独接受 GT 治疗后得到改善，无需 GJ 管或胃底折叠术。GT 和 GJ 管与症状和 QOL 的改善相关。GJ 管患者报告的 QALMS 获益更大，但产生的费用更高。进一步分析每个额外 QALM 的支付意愿将有助于确定护理的价值。
成本效益研究，二级。
