Number of DDH by year of birth and year of diagnosis.

<p>The accumulated cases in one birth-year cohort were divided by the total live births to calculate DDH incidence.</p

Incidence of DDH per thousand was stratified by the diagnosis age and the ratio of early diagnosis over late diagnosis from 2000 to 2005.

<p>Incidence of DDH per thousand was stratified by the diagnosis age and the ratio of early diagnosis over late diagnosis from 2000 to 2005.</p

Distribution of major and minor surgeries by operation age revealed a strong association between surgical type and age.

<p>Incidence of major surgeries decreased gradually from 2002.</p

The influence of health policy on early diagnosis and surgical incidence of developmental dysplasia of the hip

<div><p>Background</p><p>Hip screening is the standard approach for the early detection of developmental dysplasia of the hip (DDH). However, there is a lack of evidence regarding the effects of national policy on early diagnosis and later surgical incidence. The purpose of this national study is to estimate DDH incidence in the Taiwanese population through a new diagnosis definition and to examine whether a health promotion policy could reduce surgeries for DDH.</p><p>Methods and results</p><p>Six birth-year cohorts (2000–2005) were evaluated for DDH diagnosis and related surgeries using the database of the National Health Insurance Administration, which covers 99% of the population of Taiwan. Children with three or more sequential International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes (754.3x) in the outpatient claim file or DDH-related surgeries were studied. The outcome of hip screening was evaluated with the ratio of early diagnosis (0–6 months) to late diagnosis (1–5 years) and the incidence of major surgeries for DDH. DDH incidence was 1.54 per thousand live births (2,255/1,462,539). After a hip screening promotion policy was implemented in 2002, ratios of early/late diagnosis increased from 1.06, 1.25, 1.38, and 1.5 to 1.75 for the years 2000 to 2005, respectively. Incidences of major surgery decreased from 0.41–0.47 per thousand before policy administration to 0.33–0.37 per thousand after policy administration.</p><p>Discussion</p><p>The DDH incidence of 1.54 per 1,000 in a geographically well-defined area offered epidemiological data for further studies in Asian populations. The results suggest that the health promotion policy is associated with an increase in early diagnosis and subsequently a decrease in surgeries for DDH.</p></div

Numbers of surgical cases stratified by operation age and the surgical incidence in the six cohorts.

<p>Numbers of surgical cases stratified by operation age and the surgical incidence in the six cohorts.</p

Flowchart of identification of study subjects.

<p>Flowchart of identification of study subjects.</p

Decreasing incidence of surgery in the six birth-year cohorts.

<p>Decreasing incidence of surgery in the six birth-year cohorts.</p

Cost per QALY (Quality-Adjusted Life Year) and Lifetime Cost of Prolonged Mechanical Ventilation in Taiwan

<div><h3>Introduction</h3><p>Patients who require prolonged mechanical ventilation (PMV) are increasing and producing financial burdens worldwide. This study determines the cost per QALY (quality-adjusted life year), out-of-pocket expenses, and lifetime costs for PMV patients stratified by underlying diseases and cognition levels.</p> <h3>Methods</h3><p>A nationwide sample of 50,481 patients with continual mechanical ventilation for more than 21 days was collected during 1997–2007. After stratifying the patients according to specific diagnoses, a latent class analysis (LCA) was performed to categorise PMV patients with multiple co-morbidities into several homogeneous groups. The survival functions were estimated for individual groups using the Kaplan-Meier method and extrapolated to 300 months through a semi-parametric method. The survival functions were adjusted using an EQ-5D utility value derived from a convenience sample of 142 PMV patients to estimate quality-adjusted life expectancies (QALE). Another convenience sample of 165 patients was used to estimate the out-of-pocket expenses. The lifetime expenditures paid by the single-payer National Health Insurance (NHI) system and patients' families were estimated by multiplying average monthly expenditures by the survival probabilities and summing the values over lifetime.</p> <h3>Results</h3><p>PMV therapy costs more than 100,000 U.S. dollars (USD) per QALY for all patients with poor cognition. For patients with partial cognition, PMV therapy costs less than 56,000 USD per QALY for those with liver cirrhosis, intracranial or spinal cord injuries, and 57,000–69,000 USD for patients with multiple co-morbidities under age of 65. The average lifetime cost of PMV was usually below 56,000 USD. The out-of-pocket expenses were often more than one-third of the total cost of treatment.</p> <h3>Conclusions</h3><p>PMV treatment for patients with poor cognition would cost more than 5 times Taiwan's GDP (gross domestic products), or less cost-effective. The out-of-pocket expenses for PMV provision should also be considered in policy decision.</p> </div

Flow chart of the computation process for lifetime costs and cost-per-QALY (quality-adjusted life year).

<p>Flow chart of the computation process for lifetime costs and cost-per-QALY (quality-adjusted life year).</p

Lifetime cost and cost per QALY (quality-adjusted life year) for patients undergoing prolonged mechanical ventilation in Taiwan, stratified by underlying diseases (Dis.), with sensitivity analysis of quality-adjusted life expectancy (QALE) under different states of cognition.

*<p>SE: standard error of the mean.</p>†<p>Dis. : diseases.</p