Cost-Effectiveness Analysis of the Surgical Management of Infants Less than One Year of Age with Feeding Difficulties
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Read the article on jpedsurg.org ↗Article · Nov 2019 · 1 min read
In brief
In brief
This prospective study evaluates the cost-effectiveness of three surgical approaches for managing feeding difficulties in infants under one year: gastrostomy alone, gastrostomy with fundoplication, and gastrojejunostomy. Results show that 86% of infants did well with gastrostomy alone, with significant improvement in GERD symptoms and quality of life at one-year follow-up.
Written by the GCMD Library team from the article.
Background
We compared the cost-effectiveness of the common surgical strategies for the management of infants with feeding difficulty.
Methods
Infants with feeding difficulty undergoing gastrostomy alone (GT), GT and fundoplication, or gastrojejunostomy (GJ) tube were enrolled between 2/2017 and 2/2018. A validated GERD symptom severity questionnaire (GSQ) and visual analog scale (VAS) to assess quality of life (QOL) were administered at baseline, 1 month, and every 6 months. Data collected included demographics, resource utilization, diagnostic studies, and costs. VAS scores were converted to quality adjusted life months (QALMs), and costs per QALM were compared using a decision tree model.
Results
Fifty patients initially had a GT alone (71% laparoscopically), and one had a primary GJ. Median age was 4 months (IQR 3–8 months). Median follow-up was 11 months (IQR 5–13 months). Forty-three did well with GT alone. Six (12%) required conversion from GT to GJ tube, and one required a fundoplication. Of those with GT alone, six (14%) improved significantly so that their GT was removed after a mean of 7 ± 3 months. Overall, the median GSQ score improved from 173 at baseline to 18 after 1 year (p