Healthcare service use and medical outcomes of tracheostomy-dependent children: a nationwide study.

BACKGROUND: Despite the rising trend of tracheostomies in children, there is a lack of comprehensive resources for families to navigate the challenges of living with a tracheostomy, emphasising the need for evidence-based support in understanding postoperative care and long-term adjustments. This study aimed to examine the pattern of using healthcare services and nationwide medical outcomes in children who underwent a tracheotomy before the age of 2 years. METHODS: This retrospective study used the National Health Insurance System database from 2008 to 2016 and included all children codified with tracheotomy procedure codes before their second birthday. Healthcare utilisation, such as medical costs, number of hospital visits, home healthcare nursing and medical diagnoses on readmission, in the first 2 years after tracheotomy was evaluated. Multivariable logistic regression analysis was used to determine the factors affecting mortality. RESULTS: In total, 813 patients were included in this study. Their use of healthcare services and the accompanying expenses were higher than the national medians for similar age groups; however, both metrics decreased in the second year. The major causes of admission within 2 years of surgery were respiratory and neurological diseases. The mortality rate within 2 years was 37.8%. Higher risks of mortality were associated with having two or more complex chronic conditions. Use of home healthcare nursing services was associated with a lower mortality risk. CONCLUSION: Paediatric patients with more complex chronic conditions tended to have higher mortality rates within 2 years after surgery. However, receiving home healthcare nursing was significantly associated with a reduced risk of death. Many causes of hospitalisation may be preventable with education and supportive care. Therefore, further research for establishing an integrated care system for these patients and their caregivers is required.

Survival of children with trisomy 18 associated with the presence of congenital heart disease and intervention in the Republic of Korea.

BACKGROUND: Trisomy 18 syndrome (T18) is the second most common autosomal trisomy and has a high risk of fetal loss and stillbirth. Aggressive surgical treatments for the respiratory, cardiac, or digestive systems of patients with T18 were previously futile, while the results of recent studies are controversial. Over the past decade, there have been approximately 300,000 to 400,000 births annually in the Republic of Korea; however, there have been no nationwide studies on T18. This nationwide retrospective cohort study aimed to determine the prevalence of T18 in Korea and its prognosis according to the presence of congenital heart disease and relevant interventions. METHODS: This study utilized NHIS-registered data between 2008 and 2017. A child was defined as having T18 if the ICD-10 revision code Q91.0-3 was reported. Subgroup analysis was performed for children with congenital heart diseases, and survival rates were compared based on the history of cardiac surgical or catheter interventions. The primary outcomes in this study were the survival rate during the first hospitalization period and the 1-year survival rate. RESULTS: Of the children born between 2008 and 2017, 193 were diagnosed with T18. Of these, 86 died, with a median survival of 127 days. The 1-year survival rate for children with T18 was 63.2%. The survival rate in the first admission of children with T18 who did and did not have congenital heart disease was 58.3% and 94.1%, respectively. Children with heart disease who underwent surgical or catheter intervention had a longer survival time than those who did not. CONCLUSIONS: We suggest these data could be used in ante- and postnatal counseling. Ethical concerns about the prolonged survival of children with T18 remain; however, the potential benefits of interventions for congenital heart disease in this population need further study.

Systematic Review and Quality Assessment of Health Economic Evaluation Studies (2007-2019) Conducted in South Korea.

BACKGROUND: South Korea formally adopted economic evaluation in December 2006 to aid drug reimbursement decision-making. While this policy change is applied only to pharmaceuticals, it has also sparked interest in economic evaluations for non-pharmaceutical interventions and programmes. OBJECTIVE: This study aimed to provide a snapshot of the current practice for published health economic evaluation studies and critically assess the quality of these studies. METHODS: An electronic search was performed on multiple databases (EMBASE, PubMed, NHS Economic Evaluation Database, Scopus, Korean Medical database, Korean studies Information Service System, and Research Information Sharing Service) to identify health economic evaluation studies published between January 2007 and December 2019. The inclusion criteria were peer-reviewed, original health economic evaluations (cost-utility, cost-effectiveness, cost-minimisation, and cost-benefit analyses) published in English or Korean. Two reviewers selected studies for inclusion and extracted data from the included studies. Key characteristics of these studies were descriptively summarised, and study quality was assessed using the Quality of Health Economic Studies (QHES) instrument on a 100-point scale. RESULTS: A total of 162 studies were included in this review (63 for drugs, 51 for non-pharmaceutical treatments/health technologies, and 48 for health programmes). These numbers confirm a significant increase in the number of publications since the policy introduction. However, the quality of these studies remained relatively low, with a mean QHES score of 57.9 (± 16.0). Study quality also varied substantially, with the QHES scores ranging from 15 to 87. The scores were notably lower in studies with non-pharmaceutical interventions and programmes, cost-effectiveness analyses or cost-benefit analyses, retrospective study-based or simple modelling-based analyses, and those locally published. In addition, a considerable proportion of these studies did not state or specify essential components of economic evaluation, such as perspectives (30.2%), time horizons (29.6%), discount rates (34.6%), and sensitivity analyses (24.7%). While the use of local data either fully or partially was relatively higher for unit costs (94.4%) and resource utilisation (90.1%), it was lower for utility weights (47.1%), treatment effects (63.0%), and baseline risks (70.4%). Transferability or generalisability issues were infrequently discussed when relying on foreign sources. In addition, the included studies were often not well structured, making it difficult to assess their quality. CONCLUSION: These findings suggest that there is still much room for improving the quality of health economic evaluation studies conducted in South Korea. Policymakers should critically evaluate available cost-effectiveness evidence, especially for non-pharmaceutical interventions and programmes, when using it for decision-making in South Korea.

Association between birth weight and neurodevelopmental disorders assessed using the Korean National Health Insurance Service claims data.

The risk of neurodevelopmental disorders in low birth weight (LBW) infants has gained recognition but remains debatable. We investigated the risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in school-aged children according to their birth weight. We conducted a retrospective cohort study using the Korean National Health Insurance claims data of 2,143,652 children who were born between 2008 and 2012. Gestational age of infants was not available; thus, outcomes were not adjusted with it. Not only infants with birth weights of < 1.5 kg, but also 2.0-2.4 kg and 1.5-1.9 kg were associated with having ADHD; odds ratio (OR), 1.41 (95% confidence interval [CI] 1.33-1.50), and 1.49 (95% CI 1.33-1.66), respectively. The OR in infants with birth weights of 2.0-2.4 kg and 1.5-1.9 kg was 1.91 (95% CI 1.79-2.05) and 3.25 (95% CI 2.95-3.59), respectively, indicating increased odds of having ASD. Subgroup analysis for children without perinatal diseases showed similar results. In this national cohort, infants with birth weights of < 2.5 kg were associated with ADHD and ASD, regardless of perinatal history. Children born with LBW need detailed clinical follow-up.