Weighing Cost and Mortality Risk for Necrotizing Enterocolitis

Diedtra Henderson

April 13, 2015

Of three surgical approaches for managing necrotizing enterocolitis (NEC) in infants, peritoneal drainage followed by laparotomy had relatively low mortality risk, at 35%, but at $398,173, the two-step approach had a higher price tag than the other alternatives, according to an adjusted analysis of cost and mortality.

Anne Stey, MD, from the Department of Surgery, Mount Sinai Medical Center, New York City; and Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, and coauthors report their findings online April 13 in Pediatrics.

NEC, death of tissue lining the intestinal wall, is a life-threatening condition that occurs most often in premature or sick infants, according to the National Institutes of Health. According to Dr Stey and coauthors, mortality rates range from 18% to 63%, and treatment costs are "considerable," with peritoneal drainage used as both final therapy and a bridge for infants who ultimately receive laparotomy. In some cases, infants receive laparotomy alone.

The research team examined records for infants treated in high-level neonatal intensive care units in California between 1999 and 2007 to compare mortality rates and costs for each of the three surgical management options for NEC. They were able to propensity score match 699 infants. Of those, 101 infants underwent peritoneal drainage alone with a mortality rate of 56% (95% confidence interval [CI], 34% - 75%) and total in-hospital costs of $276,076. Another 172 infants underwent peritoneal drainage followed by laparotomy with a mortality rate of 35% (95% CI, 19% - 56%) and total in-hospital costs of $398,173. In addition, 426 infants underwent laparotomy alone, with a mortality rate of 29% (95% CI, 19% - 56%) and total in-hospital costs of $341,911.

"[I]nfants who underwent laparotomy alone and infants who underwent peritoneal drainage followed by laparotomy had comparably lower mortality rates than infants who underwent peritoneal drainage alone," Dr Stey and colleagues write. "However, peritoneal drainage followed by laparotomy demonstrated significantly higher total in-hospital costs than peritoneal drainage alone."

According to the authors, peritoneal drainage followed by laparotomy provides "equally good" outcomes as laparotomy alone, but additional cost/benefit analysis is needed.

"Peritoneal drainage followed by laparotomy was associated with decreased mortality compared with peritoneal drainage alone but at significantly increased costs. These findings imply that economic analyses of prospectively gathered cost data are needed to determine not only which intervention has the best outcomes but the highest value," the authors conclude.

Financial support for the study was provided by the Fubon Foundation and the National Institutes of Health. Two study authors disclosed receiving funding from the Robert Wood Johnson Clinical Scholars Program. A third author disclosed receiving funding from the National Institutes of Health and the Fubon Foundation. The remaining five authors have disclosed no relevant financial relationships.

Pediatrics. Published online April 13, 2015.

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