Early cost-utility estimation of the surgical correction of pectus excavatum with the Nuss bar
Abstract OBJECTIVES The surgical correction of pectus excavatum (PE) with a Nuss bar provides satisfactory outcomes, but its cost-effectiveness is yet unproven. We prospectively analysed early outcomes and costs for Nuss bar placement. METHODS Fifty-four patients aged 16 years or older (6 females an...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2019-04, Vol.55 (4), p.699-703 |
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| container_title | European journal of cardio-thoracic surgery |
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| creator | Zuidema, Wietse P Oosterhuis, Jan W A van der Heide, Stefan M Zijp, Gerda W van Baren, Robertine van der Steeg, Alida F W van Heurn, Ernst L W E |
| description | Abstract
OBJECTIVES
The surgical correction of pectus excavatum (PE) with a Nuss bar provides satisfactory outcomes, but its cost-effectiveness is yet unproven. We prospectively analysed early outcomes and costs for Nuss bar placement.
METHODS
Fifty-four patients aged 16 years or older (6 females and 48 males; mean age, 17.9 years; range 16.0–29.4 years) with a PE filled out a Short Form-36 Health Survey (SF-6D) preoperatively and 1 year after a Nuss procedure. Costs included professional fees and fees for the operating room, materials and hospital care. Changes in the responses to the SF-36 or its domains were compared using the Wilcoxon signed rank test and the utility test results were calculated preoperatively and postoperatively from the SF-6D. The quality-adjusted life years (QALYs) were calculated from the results of these tests.
RESULTS
Significant improvements in physical functioning, social functioning, mental health and health transition (all P €80 000/QALY) for patients with PE 1 year after Nuss bar placement. Based on this discrepancy, general health outcome measurements as the basis for cost-utility analysis in patients with PE may not be the best way forward. |
| doi_str_mv | 10.1093/ejcts/ezy348 |
| format | Article |
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OBJECTIVES
The surgical correction of pectus excavatum (PE) with a Nuss bar provides satisfactory outcomes, but its cost-effectiveness is yet unproven. We prospectively analysed early outcomes and costs for Nuss bar placement.
METHODS
Fifty-four patients aged 16 years or older (6 females and 48 males; mean age, 17.9 years; range 16.0–29.4 years) with a PE filled out a Short Form-36 Health Survey (SF-6D) preoperatively and 1 year after a Nuss procedure. Costs included professional fees and fees for the operating room, materials and hospital care. Changes in the responses to the SF-36 or its domains were compared using the Wilcoxon signed rank test and the utility test results were calculated preoperatively and postoperatively from the SF-6D. The quality-adjusted life years (QALYs) were calculated from the results of these tests.
RESULTS
Significant improvements in physical functioning, social functioning, mental health and health transition (all P < 0.05) were noted. The other SF-36 subgroups showed improvement; however, the improvement was not significant. The SF-6D utility showed improvement from 0.76 preoperatively to 0.79 at the 1-year follow-up (P = 0.096). The mean direct costs were €8805. The 1-year discounted QALY gain was 0.03. The estimated cost-utility ratio was €293 500 per QALY gained.
CONCLUSIONS
Despite a significant improvement in many domains of the SF-36, the results of the SF-6D cost-utility analysis showed only a small improvement in cost-effectiveness (> €80 000/QALY) for patients with PE 1 year after Nuss bar placement. Based on this discrepancy, general health outcome measurements as the basis for cost-utility analysis in patients with PE may not be the best way forward.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezy348</identifier><identifier>PMID: 30380039</identifier><language>eng</language><publisher>Germany: Oxford University Press</publisher><ispartof>European journal of cardio-thoracic surgery, 2019-04, Vol.55 (4), p.699-703</ispartof><rights>The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2018</rights><rights>The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c318t-8c1556dd2e485bedc7ef18d3e1a16b40986b8c26e7d271edd1441074f217470d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30380039$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zuidema, Wietse P</creatorcontrib><creatorcontrib>Oosterhuis, Jan W A</creatorcontrib><creatorcontrib>van der Heide, Stefan M</creatorcontrib><creatorcontrib>Zijp, Gerda W</creatorcontrib><creatorcontrib>van Baren, Robertine</creatorcontrib><creatorcontrib>van der Steeg, Alida F W</creatorcontrib><creatorcontrib>van Heurn, Ernst L W E</creatorcontrib><title>Early cost-utility estimation of the surgical correction of pectus excavatum with the Nuss bar</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>Abstract
OBJECTIVES
The surgical correction of pectus excavatum (PE) with a Nuss bar provides satisfactory outcomes, but its cost-effectiveness is yet unproven. We prospectively analysed early outcomes and costs for Nuss bar placement.
METHODS
Fifty-four patients aged 16 years or older (6 females and 48 males; mean age, 17.9 years; range 16.0–29.4 years) with a PE filled out a Short Form-36 Health Survey (SF-6D) preoperatively and 1 year after a Nuss procedure. Costs included professional fees and fees for the operating room, materials and hospital care. Changes in the responses to the SF-36 or its domains were compared using the Wilcoxon signed rank test and the utility test results were calculated preoperatively and postoperatively from the SF-6D. The quality-adjusted life years (QALYs) were calculated from the results of these tests.
RESULTS
Significant improvements in physical functioning, social functioning, mental health and health transition (all P < 0.05) were noted. The other SF-36 subgroups showed improvement; however, the improvement was not significant. The SF-6D utility showed improvement from 0.76 preoperatively to 0.79 at the 1-year follow-up (P = 0.096). The mean direct costs were €8805. The 1-year discounted QALY gain was 0.03. The estimated cost-utility ratio was €293 500 per QALY gained.
CONCLUSIONS
Despite a significant improvement in many domains of the SF-36, the results of the SF-6D cost-utility analysis showed only a small improvement in cost-effectiveness (> €80 000/QALY) for patients with PE 1 year after Nuss bar placement. Based on this discrepancy, general health outcome measurements as the basis for cost-utility analysis in patients with PE may not be the best way forward.</description><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kD1PwzAQhi0EoqWwMaNsMBBqx07sjKgqH1IFC0hMRI59oanSpvgDCL8e07SMTPdK99wr3YPQKcFXBOd0DAvl7Bi-O8rEHhoSwWnMKXvZDxkTHPOc4QE6snaBMc5owg_RgGIqMKb5EL1OpWm6SLXWxd7VTe26CKyrl9LV7Spqq8jNIbLevNVKNoEzBtRutQ7R2wi-lPyQzi-jz9rNNwcP3tqolOYYHVSysXCynSP0fDN9mtzFs8fb-8n1LFaUCBcLRdI00zoBJtIStOJQEaEpEEmykuFcZKVQSQZcJ5yA1oQxgjmrEsIZx5qO0EXfuzbtuw8PFMvaKmgauYLW2yIhSfCQ5SIN6GWPKtNaa6Aq1ia8a7qC4OLXaLExWvRGA362bfblEvQfvFMYgPMeaP36_6ofP4uCGQ</recordid><startdate>20190401</startdate><enddate>20190401</enddate><creator>Zuidema, Wietse P</creator><creator>Oosterhuis, Jan W A</creator><creator>van der Heide, Stefan M</creator><creator>Zijp, Gerda W</creator><creator>van Baren, Robertine</creator><creator>van der Steeg, Alida F W</creator><creator>van Heurn, Ernst L W E</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190401</creationdate><title>Early cost-utility estimation of the surgical correction of pectus excavatum with the Nuss bar</title><author>Zuidema, Wietse P ; Oosterhuis, Jan W A ; van der Heide, Stefan M ; Zijp, Gerda W ; van Baren, Robertine ; van der Steeg, Alida F W ; van Heurn, Ernst L W E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c318t-8c1556dd2e485bedc7ef18d3e1a16b40986b8c26e7d271edd1441074f217470d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zuidema, Wietse P</creatorcontrib><creatorcontrib>Oosterhuis, Jan W A</creatorcontrib><creatorcontrib>van der Heide, Stefan M</creatorcontrib><creatorcontrib>Zijp, Gerda W</creatorcontrib><creatorcontrib>van Baren, Robertine</creatorcontrib><creatorcontrib>van der Steeg, Alida F W</creatorcontrib><creatorcontrib>van Heurn, Ernst L W E</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zuidema, Wietse P</au><au>Oosterhuis, Jan W A</au><au>van der Heide, Stefan M</au><au>Zijp, Gerda W</au><au>van Baren, Robertine</au><au>van der Steeg, Alida F W</au><au>van Heurn, Ernst L W E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early cost-utility estimation of the surgical correction of pectus excavatum with the Nuss bar</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2019-04-01</date><risdate>2019</risdate><volume>55</volume><issue>4</issue><spage>699</spage><epage>703</epage><pages>699-703</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>Abstract
OBJECTIVES
The surgical correction of pectus excavatum (PE) with a Nuss bar provides satisfactory outcomes, but its cost-effectiveness is yet unproven. We prospectively analysed early outcomes and costs for Nuss bar placement.
METHODS
Fifty-four patients aged 16 years or older (6 females and 48 males; mean age, 17.9 years; range 16.0–29.4 years) with a PE filled out a Short Form-36 Health Survey (SF-6D) preoperatively and 1 year after a Nuss procedure. Costs included professional fees and fees for the operating room, materials and hospital care. Changes in the responses to the SF-36 or its domains were compared using the Wilcoxon signed rank test and the utility test results were calculated preoperatively and postoperatively from the SF-6D. The quality-adjusted life years (QALYs) were calculated from the results of these tests.
RESULTS
Significant improvements in physical functioning, social functioning, mental health and health transition (all P < 0.05) were noted. The other SF-36 subgroups showed improvement; however, the improvement was not significant. The SF-6D utility showed improvement from 0.76 preoperatively to 0.79 at the 1-year follow-up (P = 0.096). The mean direct costs were €8805. The 1-year discounted QALY gain was 0.03. The estimated cost-utility ratio was €293 500 per QALY gained.
CONCLUSIONS
Despite a significant improvement in many domains of the SF-36, the results of the SF-6D cost-utility analysis showed only a small improvement in cost-effectiveness (> €80 000/QALY) for patients with PE 1 year after Nuss bar placement. Based on this discrepancy, general health outcome measurements as the basis for cost-utility analysis in patients with PE may not be the best way forward.</abstract><cop>Germany</cop><pub>Oxford University Press</pub><pmid>30380039</pmid><doi>10.1093/ejcts/ezy348</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| title | Early cost-utility estimation of the surgical correction of pectus excavatum with the Nuss bar |
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