Healthcare use and direct medical costs in a cleft lip and palate population: an analysis of observed and protocolized care and costs

Differences in the surgical and financial burden of four protocols for unilateral cleft lip and palate

The treatment of unilateral cleft lip and palate (UCLP) involves up to four primary surgeries to restore oral function. This study was performed to evaluate the surgical burden and direct healthcare costs of four UCLP surgical protocols at Erasmus University Medical Centre, Rotterdam, to guide optimal protocol selection. This retrospective cohort study included UCLP patients treated during 1990-2024. The patients were categorized into groups based on the hard palate closure timing: Oslo protocol (OP), one-stage palatoplasty protocol (OSPP), early delayed hard palate closure protocol (E-DHPCP), and late delayed hard palate closure protocol (L-DHPCP). Primary surgeries were analysed for operative duration (OD) and length of hospital stay (LOS), and their associated costs were estimated. Overall, 331 patients were included. Mean cumulative OD was significantly shorter for L-DHPCP and OSPP when compared to E-DHPCP and OP, while mean cumulative LOS was significantly longer for E-DHPCP compared to the other protocols. Mean cumulative OD was 408, 465, 425, and 507 min, and mean cumulative LOS was 3.95, 4.84, 4.07, and 4.11 nights for L-DHPCP, E-DHPCP, OSPP, and OP, respectively. Mean total costs were estimated at €17,858, €20,791, €18,545, and €21,158, respectively. L-DHPCP and OSPP demonstrated the lowest surgical burden and direct healthcare costs, although differences were minor. Therefore, the choice between these four surgical protocols should continue to be based on clinical outcomes, rather than differences in burden and costs.

Diagnostic Methods for the Prenatal Detection of Cleft Lip and Palate: A Systematic Review

Background: Accurate prenatal diagnosis of cleft lip and palate is essential to discuss severity prediction, perform appropriate parental counseling, and, at last, establish long-term treatment planning. The aim of this systematic review was to analyze the accuracy of various imaging techniques for the prenatal diagnosis of cleft lip and palate, assess the pregnancy phase for orofacial clefts diagnosis, and study the different cleft types in terms of diagnostic methods, timing, and predictability. Methods: A search of the PubMed, EMBASE, Scopus, and Web of Science databases was conducted to identify potentially relevant studies published until January 2024. The quality of the selected articles was assessed using the Newcastle-Ottawa scale for methodological quality assessment of cohort studies and the QUADAS-2 scale for diagnostic test studies. Results: A total of 18 studies met the eligibility criteria and were included in the review. The findings of this review indicate that the majority of studies showed improved diagnostic accuracy when supplementary techniques, such as 3D ultrasound or magnetic resonance imaging, were added to 2D ultrasound. Conclusions: The implementation of magnetic resonance imaging as a standard procedure could significantly improve the precision of diagnosing cleft lip and palate. Therefore, the diagnostic technique used will play a crucial role in the accuracy of the diagnosis.