Micro-costing analysis of National Health Service secondary care for children born with unilateral cleft lip and palate, bilateral cleft lip and palate, and cleft palate only, from alveolar bone graft up to 20 years of age

University of Bristol Orthodontic DDS research project

Assessing the cost to the NHS of providing care for patients with cleft lip and/or palate

Aims
To conduct a micro-costing analysis to assess the cost to the NHS of treatment in secondary care
for children born with unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP),
and cleft palate only (CPO), from post-alveolar bone graft up to 20 years of age. To compare the
micro-costed values to the national average, via the NHS reference costs, and to the National
Tariff.
Method
A care pathway was mapped out for children born with UCLP, BCLP and CPO from alveolar bone
graft to 20 years. Retrospective data collection from the hospital clinical record was performed
for 23 individuals who had undergone treatment for non-syndromic UCLP (10 individuals), BCLP
(3) and CPO (10) with the South West Cleft Team. Unit costs from local and national sources
were applied to each item of resource use.
Results
The mean cost per child was £7977 (UCLP), £9416 (BCLP) and £3809 (CPO). The cost of BCLP
care was 15% more than UCLP and 60% more than CPO. Surgical treatment and orthodontic
treatment accounted for a large proportion of the costs. The need for repeat surgery had a
marked impact on cost. For most activities, the micro-costed figure was less than the national
average and compared similarly with the National Tariff.
Conclusion
The biggest cost drivers were the number of outpatient appointments and the need for repeat
surgery. Remote consultation and service improvement programmes are two possible
approaches for reducing the associated time and financial implications.