Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles.
Division of Plastic and Maxillofacial Surgery, Keck School of Medicine.
J Craniofac Surg. 2021;32(2):574-577. doi: 10.1097/SCS.0000000000007026.
Over the last 3 years a shift at our institution has taken place in which patients who would have been offered nasoalveolar molding (NAM) as an adjunct to cleft lip repair (repair after 3 months) have instead undergone early cleft lip repair (ECLR) (2-5 weeks of life) without NAM. This study sought to examine the financial and social impact of the transition away from NAM to ECLR. The efficacy of NAM is limited by patient compliance to a rigorous treatment schedule requiring weekly visits for appliance adjustments. Nasoalveolar molding patients required an average of 11 dental visits, accounting for $2132 in indirect lost income per family. Average direct charges for NAM totaled $12,290 for the hospital, physician, and appliance costs. Over the entire study period, the cumulative direct cost of NAM separate from the surgical repair of the lip was $970,910. Following the introduction of ECLR as an alternative to NAM with standard lip repair, NAM usage decreased by 48% and unilateral cleft lip patients undergoing NAM decreased by 86%. Those diverted from NAM to ECLR resulted in a decreased healthcare cost burden of $368,700 ($111,727 per year). In addition to the time burden, the financial burden of NAM is significant. Early cleft lip repair without NAM is more cost effective. Nasoalveolar molding has significantly decreased utilization since the implementation of ECLR. We believe that ECLR, with increased experience, long-term data, and increased awareness, has the potential to decrease the burden of health care costs in the United States.
在过去的 3 年中，我们机构发生了转变，以前接受过鼻牙槽塑形术（NAM）治疗的患者，该手术是作为唇裂修复术（3 个月后）的辅助手段，现在转而接受早期唇裂修复术（ECLR）（出生后 2-5 周），但没有接受 NAM。本研究旨在探讨从 NAM 到 ECLR 的转变对财务和社会的影响。NAM 的疗效受到患者对每周进行一次器械调整的严格治疗方案的依从性的限制。接受 NAM 的患者平均需要 11 次牙科就诊，每个家庭的间接收入损失为 2132 美元。NAM 的平均直接费用总计为 12290 美元，包括医院、医生和器械费用。在整个研究期间，NAM 的直接成本（不包括唇裂的手术修复）总计为 970910 美元。在引入 ECLR 作为 NAM 替代方案以治疗标准唇裂后，NAM 的使用率下降了 48%，接受 NAM 的单侧唇裂患者下降了 86%。从 NAM 转用 ECLR 可减少 368700 美元的医疗保健费用负担（每年 111727 美元）。除了时间负担外，NAM 的财务负担也很沉重。不使用 NAM 进行早期唇裂修复更具成本效益。自 ECLR 实施以来，NAM 的使用率显著下降。我们相信，随着经验的增加、长期数据的积累以及意识的提高，ECLR 有可能降低美国医疗保健成本的负担。
