87 / 280
the first year were no different (
P
= .83) between the MD
group ($53,489) and the Trach
1
MD group ($59,761),
whereas the Trach group ($96,674) continued to be signifi-
cantly higher than the MD group (
P
= .002).
The first year was divided into quartiles for a further anal-
ysis of associated charges (
Figure 1
). As expected, all
groups had the greatest charges during the first quartile, cor-
responding with the initial admission and operations, with no
differences between groups (
P
= .28). The low median
charges of the Trach
1
MD group during the first quartile
were influenced by a delay in receiving MD until after the
initial tracheostomy. Over the last 3 quartiles, charges for the
MD group were significantly less than those of the other 2
groups (
P
\
.0001).
A 3-year follow-up period was examined for all patients
(
Figure 2
). As with the first year (
P
= .017), charges from
the Trach and Trach
1
MD groups continued to be signifi-
cantly greater than the MD group in years 2 (
P
\
.0001) and
3 (
P
= .0003). These increased costs correlate positively with
increased numbers of operations (
P
\
.0001) and ER visits
(
P
= .016) for patients receiving tracheostomy (
Table 3
).
To incorporate home tracheostomy care-related costs, a
personalized estimate was made for each patient based on
individual requirement for respiratory support, length of
time prior to decannulation, and charges related to equip-
ment rental, tracheostomy supplies, and home nursing care.
These home care charges were combined with actual
Table 3.
Three Year Cost-Related Aspects of Mandibular Distraction versus Tracheostomy.
Treatment
MD
n = 26
Trach
n = 12
Trach
1
MD
n = 9
P
Value
a
Median number operations year 1 (range)
(Mean)
3.5 (2-6)
(3.6)
5 (2-6)
(4.4)
6 (4-8)
(6.0)
.0006
Median number operations years 1-3 (range)
(Mean)
4 (2-11)
(3.9)
b
10 (6-12)
(9.2)
8 (4-15)
(9.8)
\
.0001
Median number ER visits years 1-3 (range)
(Mean)
0 (0-14)
(1.0)
1.5 (0-11)
(3.2)
1 (0-10)
(3.1)
.016
Tracheostomy tube (n decannulated)
n/a
4
5
.40
Nasogastric tube (n treated, n home with, n weaned from)
22, 14, 22
4, 3, 4
c
0, 0, 0
\
.0001
Gastrostomy tube (n treated, n home with, n weaned from)
4, 3, 3
6, 3, 3
c
9, 9, 2
\
.0001
Abbreviations: MD, mandibular distraction only; Trach, tracheostomy only; Trach
1
MD, tracheostomy with subsequent mandibular distraction.
a
Kruskal-Wallis test for continuous variables or Fisher’s exact test for categorical variables.
b
Two of 26 patients in the MD group had persistent airway obstruction requiring subsequent tracheostomy.
c
For nasogastric and gastrostomy tube data, only the
proportion
of patients
treated was analyzed.
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
MD
Trach
Trach+MD
Year 1 Year 2 Year 3
Figure 2.
Annual charges ($USD) of groups over a 3-year period.
Cost analysis of patients with Pierre Robin sequence receiving
mandibular distraction (MD), tracheostomy (Trach), or tracheost-
omy with subsequent MD (Trach
1
MD), over a 3-year period
following initial treatment. Median values (horizontal line) are
presented with twenty-fifth through seventy-fifth percentile ranges.
Statistical analyses by year: year 1:
P
= .017; year 2:
P
\
.0001; year
3:
P
= .0003 (Kruskal-Wallis comparison for nonparametric data).
0
20000
40000
60000
80000
100000
120000
140000
160000
MD
Trach
Trach+MD
Q1
Q2
Q3
Q4
Figure 1.
Charges ($USD) of groups over first year by quartile.
Total charges over the first year following initial surgical interven-
tion for patients with Pierre Robin sequence receiving mandibular
distraction (MD), tracheostomy (Trach), or tracheostomy with sub-
sequent MD (Trach
1
MD). Median values (horizontal line) are pre-
sented with twenty-fifth through seventy-fifth percentile ranges.
Statistical analyses by quartile: first:
P
= .28; second through fourth:
P
\
.0001 (Kruskal-Wallis comparison for nonparametric data).
Otolaryngology–Head and Neck Surgery 151(5)
65