Tracheostomy versus Mandibular Distraction Osteogenesis in Canadian Children with Pierre Robin Sequence: A Comparative Cost Analysis

Introduction: Upper airway obstruction in newborns with Pierre Robin sequence (PRS) may be severe enough to require a surgical intervention. Tracheostomy has been the traditional gold standard, but mandibular distraction osteogenesis (MDO) has been proven to be an effective alternative procedure. Objective: The objective of the present study was to conduct the first comparative cost analysis between tracheostomy and MDO in Canada. Methods: All patients with PRS who underwent tracheostomy or MDO between January 2005 and December 2010 were included. Tracheostomy and MDO procedures were broken down into individual components, and the associated costs for these components were totaled. The average per-patient cost for each modality was then compared. Results: During the study period, 52 children underwent either a tracheostomy (n=31) or MDO (n=21). The average age at surgery, gender, and presence of associated syndromes were similar in both groups. Taking into account the cost of the surgeries, health care professional fees, and hospital stay, the total per-patient treatment cost was determined to be $57 648.55 for MDO and $92 164.45 for tracheostomy. The majority of the cost for the tracheostomy group was associated with prolonged hospital stay after the operation ($72 827.85). Overall, the average per-patient cost was 1.6 times greater in the tracheostomy group compared to the MDO group (p=.039). Conclusion: The initial cost of MDO was less than the tracheostomy cost for newborns with PRS and severe upper airway obstruction at our health care centre. Further prospective analysis considering the long-term costs is required to possibly reduce long-term health care costs.