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Hospital-based Costs to the National Health Service (UK) for Children and Adolescents Born with Cleft from Birth to
Kyle Durman1, Saleem Hasanally1, Joanna Thorn2
1Department of Oral Sciences, University of Bristol, Bristol, UK.
Insights
The National Health Service (NHS) incurs significant costs for treating cleft lip and palate conditions, with bilateral cleft lip and palate (BCLP) being the most expensive. Patients require numerous appointments, highlighting the need for care optimization.
Area of Science:
- Health Economics
- Pediatric Surgery
- Craniofacial Anomalies
Background:
- Cleft lip and palate (CLP) conditions require extensive, long-term healthcare interventions.
- Understanding the economic burden on healthcare systems is crucial for resource allocation and service planning.
Purpose of the Study:
- To determine the National Health Service (NHS) cost of hospital treatment for children with bilateral cleft lip and palate (BCLP), unilateral cleft lip and palate (UCLP), and cleft palate (CP) from birth to 20 years.
- To quantify the number of clinical outpatient and inpatient/outpatient surgical visits for this patient cohort.
Main Methods:
- A retrospective micro-costing analysis was conducted.
- Data were collected from 23 case-notes for patients from birth to secondary alveolar bone graft (ABG) and another 23 case-notes from post-ABG to 20 years.
- The study included patients treated within the South West of England Cleft Service.
Main Results:
- Mean costs from birth to ABG were £17,004 (BCLP), £11,620 (UCLP), and £6137 (CP); post-ABG to 20 years costs were £9,463 (BCLP), £7,945 (UCLP), and £3,816 (CP).
- Staff costs represented the largest expenditure, and repeat surgeries significantly impacted overall costs.
- Mean clinical outpatient visits were 140 (BCLP), 110 (UCLP), and 83 (CP); surgical visits were 8 (BCLP), 6 (UCLP), and 2 (CP).
Conclusions:
- NHS provision of cleft care, particularly for BCLP, represents a substantial financial commitment.
- Patients with BCLP require the highest number of clinical appointments.
- Recommendations include quality improvement programs to reduce repeat surgeries and exploring remote consultations to alleviate patient burden.
Abstract:
ObjectiveThe primary aim was to assess the cost (£) to the National Health Service (NHS) of hospital treatment for individuals born with bilateral cleft lip and palate (BCLP), unilateral cleft lip and palate (UCLP), and cleft palate (CP), from birth to 20 years. The secondary aim was to assess the number of scheduled clinical outpatient and inpatient/outpatient surgical visits for this cohort.DesignRetrospective micro-costing analysis.SettingPatients treated within the South West of England Cleft Service (UK).PatientsTwenty-three case-notes of children born with cleft (5 BCLP; 10 UCLP; 8 CP) were identified from birth up to and including secondary alveolar bone graft (ABG), and a second group of 23 hospital case-notes (3 BCLP; 10 UCLP; 10 CP) were identified, post-ABG to 20 years.ResultsMean costs from birth to ABG were £17,004 (BCLP), £11,620 (UCLP), and £6137 (CP), and post-ABG to 20 years were £9,463, £7,945, and £3,816, respectively. The largest costs were for staff. Repeat surgery had a significant impact on costs. The mean number of clinical outpatient visits for BCLP, UCLP, and CP were 140, 110 and 83 respectively and 8, 6 and 2 for inpatient/outpatient surgical visits, respectively.ConclusionsCosts for provision of cleft care by the NHS are significant. The greatest costs were incurred with care for patients with BCLP. Patients were expected to attend many appointments, with BCLP experiencing the most visits. Engagement with quality improvement programmes to minimise repeat surgery, and remote consultation for certain appointments, to reduce the patient burden are recommended.
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