Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects

Abstract

Background Clinical outcomes for transcatheter and operative closures of atrial septal defects (ASDs) are similar. Economic cost for each method has not been well described. Methods A single-center retrospective cohort study of children and adults <30 years of age undergoing closure for single secundum ASD from January 1, 2007, to April 1, 2012, was performed to measure differences in inflation-adjusted cost of operative and transcatheter closures of ASD. A propensity score weight-adjusted multivariate regression model was used in an intention-to-treat analysis. Costs for reintervention and crossover admissions were included in primary analysis. Results A total of 244 subjects were included in the study (64% transcatheter and 36% operative), of which 2% (n = 5) were ≥18 years. Crossover rate from transcatheter to operative group was 3%. Risk of reintervention (P = .66) and 30-day mortality (P = .37) were not significantly different. In a multivariate model, adjusted cost of operative closure was 2012 US $60,992 versus 2012 US $55,841 for transcatheter closure (P < .001). Components of total cost favoring transcatheter closure were length of stay, medications, and follow-up radiologic and laboratory testing, overcoming higher costs of procedure and echocardiography. Professional costs did not differ. The rate of 30-day readmission was greater in the operative cohort, further increasing the cost advantage of transcatheter closure. Sensitivity analyses demonstrated that costs of follow-up visits influenced relative cost but that device closure remained favorable over a broad range of crossover and reintervention rates. Conclusion For single secundum ASD, cost comparison analysis favors transcatheter closure over the short term. The cost of follow-up regimens influences the cost advantage of transcatheter closure.

Increasing propensity to pursue operative closure of atrial septal defects following changes in the instructions for use of the Amplatzer Septal Occluder device: An observational study using data from the Pediatric Health Information Systems database

“…Previous studies have demonstrated that TC-ASD has lower cost and shorter LOS than O-ASD(5,36). Over the study period, there were no significant changes in either following TC-ASD.…”

“…The risk of procedure-associated death in isolated TC-ASD in published series are 0–0.15%(30,34,35). The best estimates of risk-adjusted procedural mortality following O-ASD, as derived from the Society for Thoracic Surgeons Congenital Heart Surgeons Database, are between 3–9 per 1,000(5,36,37). Though there is risk standardization in these large series, care should be exercised in comparing outcomes between studies and the absolute risk of mortality with each procedure remains low.…”

“…Though there is risk standardization in these large series, care should be exercised in comparing outcomes between studies and the absolute risk of mortality with each procedure remains low. TC-ASD undeniably has other benefits over O-ASD, specifically shorter length of stay(5,36) and lower total cost relative to O-ASD(5,36), suggestive that in many cases TC-ASD represents better value than O-ASD.…”

“…As described previously, several steps were undertaken to generate cost data comparable between hospitals and across the entire study period(5,19,20). PHIS receives billing data directly from hospitals, including itemized charges.…”

“…Categorical variables were expressed as percent (count). However, prior to analysis, we suspected that baseline characteristics (age, height, weight, insurance payer, and prevalence of chronic medical conditions) would differ between TC-ASD and O-ASD cohorts as has been described previously(5). Student’s T-test, Wilcoxon rank sum test, and Chi-squared tests were used to assess differences in distribution of baseline characteristics of O-ASD and TC-ASD cohorts.…”