A microcosting study of the surgical correction of upper extremity deformity in children with spastic cerebral palsy

Figures & data

Table 1. Patient characteristics at baseline.

n	39
Age	12.38 (SD 3.7)
Sex
Male	64%
Female	36%
5–10 year success rate of surgery	80%

Table 2. Resource use and unit costs (Euro 2014), n = 39.

	Resource use	Unit costs	Costs per patient	Information source volume	Cost price
HOSPITAL COSTS
Diagnostics by multidisciplinary team
Labor (in min)
Hand surgeon	45	1.69	76.19	Hand surgeon	Hospital database
Resident hand surgery	45	0.56	25.26	Hand surgeon	Hospital database
Rehabilitation specialist	45	1.64	73.60	Hand surgeon	Hospital database
Occupational therapist	110	0.55	60.07	Occupational therapist	Hospital database
Overheads (in minutes)
Outpatient clinic by multidisciplinary team	45	0.08	3.79	Hand surgeon	Division Housing
Outpatient clinic by occupational therapist	45	0.08	3.79	Occupational therapist	Division Housing
Total costs of diagnostics by multidisciplinary team			242.69	(SD 33.70)
Consult anesthesiology
Labor (in min)
Anesthesist	20	1.61	32.20	Hospital database	Hospital database
Overheads (in min)
Outpatient clinic anesthesiology	20	0.08	1.68	Hospital database	Division Housing
Total costs of consult anesthesiology			33.89	(SD 21.59)
Hospitalization
Admission
Labor medical specialists	1	234.07	234.07	Hospital database	Hospital database
Labor other personnel	1	246.73	246.73	Hospital database	Hospital database
Materials	1	59.47	59.47	Hospital database	Hospital database
Overheads	1	391.66	391.66	Hospital database	Hospital database
Inpatient stay (in days)
Labor medical specialists	3.5	113.85	398.47	Hospital database	Hospital database
Labor other personnel	3.5	287.37	1005.81	Hospital database	Hospital database
Materials	3.5	31.87	111.55	Hospital database	Hospital database
Overheads	3.5	359.05	1256.67	Hospital database	Hospital database
Medication
Paracetamol	4	0.13	0.53	Resident hand surgery	Medicijnkosten.nl
Oxycontin	2	0.17	0.34	Resident hand surgery	Medicijnkosten.nl
Oxinorm	6	0.10	0.61	Resident hand surgery	Medicijnkosten.nl
Medical aids
Scotchcast	1	151.50	151.50	Hand surgeon	Orthopedic technician
Removable splint	1	252.50	252.50	Hand surgeon	Orthopedic technician
Night splint	1	555.50	555.50	Hand surgeon	Manufacturer
Inter physician communication
Labor (in min)
Hand surgeon	25	1.69	42.33	Hand surgeon	Hospital database
Rehabilitation specialist	10	1.69	16.93	Hand surgeon	Hospital database
Complications
Lab application	17/39	14.12	6.16	Hospital database	Nederlandse Zorgautoriteit
Electrocardiography	1/39	22.35	0.57	Hospital database	Nederlandse Zorgautoriteit
Ultrasound arm	2/39	82.49	4.23	Hospital database	Nederlandse Zorgautoriteit
Histological research	1/39	59.26	1.52	Hospital database	Nederlandse Zorgautoriteit
Ultrasound bladder	8/39	82.49	16.92	Hospital database	Nederlandse Zorgautoriteit
Scotchcast	1/39	372.69	9.56	Hospital database	Orthopedic technician
Scotchcast	1/39	559.04	14.33	Hospital database	Orthopedic technician
Total costs of hospitalization			4777.96	(SD 333.04)
Surgery
Labor (in min)
Hand surgeon	150	1.69	253.97	Hand surgeon	Hospital database
Resident hand surgery	180	0.56	101.05	Hand surgeon	Hospital database
OR assistant	420	0.57	238.28	Hand surgeon	Hospital database
Anesthesist	105	1.61	169.06	Hand surgeon	Hospital database
Resident anesthesiology	210	0.56	116.86	Hand surgeon	Hospital database
Surgery materials			201.03	Surgery center	Surgery center
General anesthesia			39.90	Hospital database	Anesthesist
Devices (in minutes)
OR	210	0.03	7.14	Division Housing	Division Housing
Recovery	120	0.01	0.83	Division Housing	Division Housing
Overheads (in minutes)
OR	210	0.84	176.75	Hand surgeon	Division Housing
Recovery	120	0.34	40.40	Hand surgeon	Division Housing
Total costs of surgery			1345.26	(SD 91.73)
New scotschcast after admission (in 10% of the children)
Labor (in minutes)
Orthopedic technician	45	0.58	2.59	Hand surgeon	Hospital database
Overheads (in min)
Plaster room	45	0.51	2.27	Hand surgeon	Division Housing
Scotchcast		151.50	15.15	Hand surgeon	Orthopedic technician
Total costs of new scotchcast after admission			20.01	(SD 7.35)
Checkup by multidisciplinary team
Labor (in minutes)
Hand surgeon	30	1.69	50.79	Hand surgeon	Hospital database
Resident hand surgery	30	0.56	16.84	Hand surgeon	Hospital database
Rehabilitation specialist	30	1.69	50.79	Hand surgeon	Hospital database
Occupational therapist	110	0.55	60.07	Occupational therapist	Hospital database
Overheads (in minutes)
Outpatient clinic by multidisciplinary team	30	0.08	2.53	Hand surgeon	Division Housing
Outpatient clinic by occupational therapist	45	0.08	3.79	Occupational therapist	Division Housing
Devices (corrected for durability)
AHA test	/ 5208	510.05	0.10	Occupational therapist and manufacturer	Occupational therapist
Box & Block test	/ 5208	285.97	0.05	Occupational therapist and manufacturer	Occupational therapist
Goniometer	/ 1562	45.45	0.03	Occupational therapist and manufacturer	Occupational therapist
Handheld dynamometer	/ 5208	338.35	0.06	Occupational therapist and manufacturer	Occupational therapist
Pinchmeter	/ 5208	292.90	0.06	Occupational therapist and manufacturer	Occupational therapist
Total costs of checkup by multidisciplinary team			185.11	(SD 24.41)
Other checkups
Labor (in min)
Hand surgeon	30	1.69	50.79	Hand surgeon	Hospital database
Orthopedic technician	120	0.58	69.01	Hand surgeon	Hospital database
Rehabilitation specialist	15	1.69	25.40	Hand surgeon	Hospital database
Overheads (in min)
Plaster room	120	0.51	60.60	Hand surgeon	Division Housing
Outpatient clinic by hand surgeon and rehabilitation specialist	30	0.08	2.53	Hand surgeon	Division Housing
Total costs of other checkups			208.33	(SD 27.32)
TOTAL HOSPITAL COSTS			6813.24	(SD 222.03)
Total costs of labor			3417.16	(SD 209.44)
Total costs of overheads			1946.45	(SD 363.51)
Total costs of medical aids			998.54	(SD 214.31)
Total costs of materials and devices			409.72	(SD 57.07)
REHABILITATION COSTS
Physiotherapy (in h)	17.5	120.96	2116.82	Rehabilitation specialist	Standard prices
Occupational therapy (in 70% of the children)	17.5	120.96	1481.78	Rehabilitation specialist	Standard prices
TOTAL COSTS OF REHABILITATION			3598.60	(SD 449.05)

Table 3. Sensitivity analysis.

	Variation unit cost value		% change in total costs when unit cost value varied by 50%	% change in hospital costs when unit cost value varied by 50%
	50%	150%
Labor	1708.58	5125.74	16.41	25.08
Overheads	973.23	2919.68	9.35	14.28
Medical aids	499.27	1497.81	4.80	7.33
Materials and devices	204.86	614.58	1.97	3.01