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Research: Center Volume and Cost-Effectiveness in the Treatment of Congenital Diaphragmatic Hernia (CDH)

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Research: Center Volume and Cost-Effectiveness in the Treatment of Congenital Diaphragmatic Hernia (CDH)

J Surg Res

. 2022 Jan 11;273:71-78. doi: 10.1016/j.jss.2021.12.016. Online ahead of print. Center Volume and Cost-Effectiveness in the Treatment of Congenital Diaphragmatic Hernia (CDH)

Center Volume and Cost-Effectiveness in the Treatment of Congenital Diaphragmatic Hernia (CDH)

Ruth Lewit 1Tim Jancelewicz 2Affiliations expand

Abstract

Background: The care of patients with congenital diaphragmatic hernia (CDH) is expensive, yet little is known about variability in cost-of-care for these patients. The purpose of this study was to examine the cost-effectiveness of CDH treatment, comparing high- versus low-volume centers.

Methods: This is a retrospective study of neonatal patients with CDH at U.S. hospitals using data from the Pediatric Health Information System database (2015-2018). Centers were considered high-volume if they had ≥10 patients with CDH for ≥ 2 y. Cost-effectiveness analysis was performed with cost per survivor as the outcome measure, and probabilistic sensitivity analysis was performed.

Results: A total of 1687 patients were included in the study. Overall mortality was 24.4%. Patients at high-volume centers had a longer mean length of stay (64 d versus 48 d for low-volume centers, P = 0.0001) and higher extracorporeal life support (ECLS) rates (32% versus 24%, P = 0.002). Risk-adjusted mortality did not differ between high- and low-volume centers (23.9% versus 25.9%, P = 0.39), except when ECLS was involved (42% versus 56%, P = 0.011). Costs were significantly higher at high-volume centers ($395,291 ± 508,351 versus $255,074 ± 308,802, P < 0.0001). Survival status, ECLS use, operative repair, length of stay, high-volume status, and gestational age were identified as independent drivers of cost. On cost-effectiveness analysis, low-volume hospitals were more cost-effective in 95% of simulations.

Conclusions: High-volume centers have substantially higher costs without an associated survival benefit and are less cost-effective than low-volume centers. Standardization of care is necessary to minimize the delivery of low-value care.

Keywords: CDH; Cost-effectiveness; Costs; High-volume.

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