Evaluating the Cost-Effectiveness of Plastic Surgery Based on the Satisfaction with Quality of Life and Nasolabial Appearance in Thai Preteens with Cleft Lip and Palate

Abstract

Background: Cleft Lip and Palate (CLP) negatively affect the quality of life (QoL) and nasolabial appearance, especially in preteen patients who start to be interested in their own appearance and society. Objective: The objective of this study is to evaluate the cost-effectiveness of plastic surgery for Thai preteen CLP patients through their satisfaction with their QoL and nasolabial appearance. Methods: A cross-sectional study covered purposively selected 30 samples aged between 8 and 12 years old.Their satisfaction with their QoL and appearance was reflected through an interview and a questionnaire with the cooperation of their parents as their caregivers including satisfaction with their nasolabial appearance evaluated by five experts. They compared the photos of patients’nasolabial appearance with those of normal faces of children of the same age using 5-rating scales. Results: General findings showed 53.3% of samples were male patients with mostly (63.3%) UCLP whose parents were mainly (73.3%) poor, so they relied on government financial supports for the treatment. Only some (15%) earned up to 5,001 to 10,000 baht per month because of their low education with just high school level. Specific findings indicated the overall satisfaction with QoL through five dimensions at average level (3.26±1.39). This was based on the satisfaction with the center services, the overall treatments, the medical additional costs, parental satisfaction with psychosocial effects including concerns about the impacts of CLP on the family ranged from high to low i.e. 4.30±0.98, 3.72±1.15, 3.70±1.14, 3.33±1.08 and 2.81±1.46 respectively. Moreover, five experts trended to be highly satisfied with patients’ nasolabial appearance by rating it from Good (53.3%) to Fair (43.43%) with only Poor (3.3%). Conclusion: The good cost-effectiveness of the surgery was represented through the average and high satisfaction of CLP patients with their QoL and their appearance respectively indicating the absence of disability weights for these treated CLP patients.

Evaluation of nasolabial esthetics in 8- to 12-year-old patients with cleft lip and palate by healthcare professionals in Northeast Thailand

“…In 1991, the aesthetic assessment was used to evaluate the index of the aesthetic of the lip and the nose by Asher-McDade et al 12 It has become widely used and found reliable when assessed by experienced medical professionals and the general public. 13 , 16 – 19 This research study, which examined the aesthetic assessment by Asher-McDade in 32 unilateral and bilateral complete CLP patients, showed that the experienced evaluators had scored at the “fair” level with a high inter-rater in all three aspects and with statistical significance (Cronbach’s alpha coefficient 0.69–0.76, p < 0.01).…”

“…In that study, it was found that the satisfaction scores by the experienced experts had been high 12 or even higher. 19 , 22 – 24 …”

“…The overall value of the result from the treatment in terms of QoL and NA in patients with CLP, who were 10 years old, 11 was analyzed using a standard deviation of 1.39 (σ 2 = 1.39) Zα/2 = 1.96, d = 0.45, N = 231, which was calculated from 32 patients at Tawanchai Center. The data were collected by taking the picture of the patients for 15 min.…”

“…However, the study did not directly reach the opinions of children due to cultural norms in Thailand where children may be hesitant to express their views on various matters. 19 However, in future studies, researchers plan to include children’s perspectives on NA assessment to further inform treatment development.…”