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Center Volume and Cost-Effectiveness in the Treatment of Congenital Diaphragmatic Hernia
1Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
High-volume centers for congenital diaphragmatic hernia (CDH) treatment incur higher costs without improving survival rates. Low-volume centers demonstrate greater cost-effectiveness, suggesting a need for standardized care protocols.
Area of Science:
- Pediatric Surgery
- Health Economics
- Neonatal Care
Background:
- Congenital diaphragmatic hernia (CDH) care is costly, with significant variability in healthcare expenses.
- Limited understanding exists regarding cost-of-care variations for CDH patients.
Purpose of the Study:
- To investigate the cost-effectiveness of congenital diaphragmatic hernia (CDH) treatment.
- To compare high-volume versus low-volume treatment centers for CDH.
Main Methods:
- Retrospective analysis of neonatal CDH patients in U.S. hospitals (2015-2018).
- High-volume centers defined as ≥10 CDH patients for ≥2 years.
- Cost-effectiveness assessed using cost per survivor; probabilistic sensitivity analysis performed.
Main Results:
- 1687 patients included; overall mortality 24.4%.
- High-volume centers had longer stays (64 vs. 48 days) and higher extracorporeal life support (ECLS) use (32% vs. 24%).
- Costs were significantly higher at high-volume centers ($395,291 vs. $255,074); low-volume hospitals were more cost-effective in 95% of simulations.
Conclusions:
- High-volume centers incur substantially higher costs without survival benefits.
- Low-volume centers are more cost-effective for congenital diaphragmatic hernia (CDH) treatment.
- Standardization of care is crucial to reduce low-value care delivery.
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.
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