Cost Effectiveness of Neonatal Surgery: a matter of balance

This thesis addresses the cost-effectiveness of neonatal surgery. Beginning after the Second World War, neonatal surgery has been making enormous progress. Mortality rates for the majority of anomalies belonging to the field fell from almost 100% to less than 10%. Contemporaneously with these medical advancements came new and pressing dilemmas. First, survival is of course an important measure of success, but improved survival might come at the price of poor health-related quality of life (HRQoL) in later life. Second, the economic consequences of health care have become larger, in an era where budgetary restrictions are becoming tighter. As in other branches of medicine, medical advancements contributed to increasing costs in neonatal surgery as well. It is against this background of concerns about the HRQoL of the surviving infant and the increasing costs associated with neonatal surgery that the need for information about the cost and effects of neonatal surgery was recognized. This thesis directly emerges from these concerns, as explained in Chapter 1. This chapter, which introduces and motivates this thesis, also explains why costs should be considered in health care, and clarifies that we will not be able to offer certain medical practices that are known to have favorable effects, but whose effects are too small to justify the cost. It highlights the relevance of costeffectiveness analyses of health care, which aim at establishing whether the effects of a given treatment are worth the budget needed, compared to an alternative treatment. For the case of neonatal surgery, results from costeffectiveness analyses would make it possible to counteract critiques leveled against the discipline. Neonatal surgery has been criticized with arguments of cost-effectiveness: the high costs of an operation have been feared to come with low HRQoL after survival. Clearly, the current lack of evidence on the costeffectiveness of neonatal surgery is a main problem worth tackling. It threatens to give the discipline a weaker position in health care allocation decisions. This study's main objective is to collect evidence on the cost-effectiveness of neonatal surgery and to place this evidence in its proper context.

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