Early cost-utility estimation of the surgical correction of pectus excavatum with the Nuss bar.

OBJECTIVES The surgical correction of pectus excavatum (PE) with a Nuss bar provides satisfactory outcomes, but its cost-effectiveness is yet unproven. We prospectively analysed early outcomes and costs for Nuss bar placement. METHODS Fifty-four patients aged 16years or older (6 females and 48 males; mean age, 17.9years; range 16.0-29.4years) with a PE filled out a Short Form-36 Health Survey (SF-6D) preoperatively and 1year after a Nuss procedure. Costs included professional fees and fees for the operating room, materials and hospital care. Changes in the responses to the SF-36 or its domains were compared using the Wilcoxon signed rank test and the utility test results were calculated preoperatively and postoperatively from the SF-6D. The quality-adjusted life years (QALYs) were calculated from the results of these tests. RESULTS Significant improvements in physical functioning, social functioning, mental health and health transition (all P<0.05) were noted. The other SF-36 subgroups showed improvement; however, the improvement was not significant. The SF-6D utility showed improvement from 0.76 preoperatively to 0.79 at the 1-year follow-up (P=0.096). The mean direct costs were Euro8805. The 1-year discounted QALY gain was 0.03. The estimated cost-utility ratio was Euro293500 per QALY gained. CONCLUSIONS Despite a significant improvement in many domains of the SF-36, the results of the SF-6D cost-utility analysis showed only a small improvement in cost-effectiveness (> Euro80000/QALY) for patients with PE 1year after Nuss bar placement. Based on this discrepancy, general health outcome measurements as the basis for cost-utility analysis in patients with PE may not be the best way forward.