In-hospital cost comparison between percutaneous pulmonary valve implantation and surgery

Abstract

OBJECTIVES: Today, both surgical and percutaneous techniques are available for pulmonary valve implantation in patients with right ventricle outflow tract obstruction or insufficiency. In this controlled, non-randomized study the hospital costs per patient of the two treatment options were identified and compared. METHODS: During the period of June 2011 until October 2014 cost data in 20 patients treated with the percutaneous technique and 14 patients treated with open surgery were consecutively included. Two methods for cost analysis were used, a retrospective average cost estimate (overhead costs) and a direct prospective detailed cost acquisition related to each individual patient (patient-specific costs). RESULTS: The equipment cost, particularly the stents and valve itself was by far the main cost-driving factor in the percutaneous pulmonary valve group, representing 96% of the direct costs, whereas in the open surgery group the main costs derived from the postoperative care and particularly the stay in the intensive care department. The device-related cost in this group represented 13.5% of the direct costs. Length-of-stay-related costs in the percutaneous group were mean $3885 (1618) and mean $17 848 (5060) in the open surgery group. The difference in postoperative stay between the groups was statistically significant (P≤ 0.001). CONCLUSIONS: Given the high postoperative cost in open surgery, the percutaneous procedure could be cost saving even with a device cost of more than five times the cost of the surgical device.

Psychosocial and clinical outcomes of percutaneous versus surgical pulmonary valve implantation

“…Among the 20 patients in the PPVI group, 16 received a Medtronic Melody valve (Medtronic, Minneapolis, Minnesota, USA) and 4 received an Edwards SAPIEN valve (Edwards Lifesciences, Irvine, California, USA). 23 Two of the patients underwent pre-stenting 1 and 3 months prior to valve implantation, while nine patients underwent pre-stenting during the implantation procedure. A median of 1 (range, 1–3) pre - stent was used.…”

“… 16 In a previous paper from the present study covering the economic effects of the herein-described treatment methods, we demonstrated that the mean length of hospital stay in the open surgery group was significantly longer than in the PPVI group. 23 This may have also affected the patients’ reported experience.…”

“…All patients in the PPVI group were extubated before leaving the angiographic suite. The patients in the open surgery group were transferred to the intensive care unit after surgery 23 and extubated when their haemodynamics and respiratory status were stable. Chest tubes were routinely removed on postoperative day 1.…”

Percutaneous Pulmonary Valve Implantation: Current Status and Future Perspectives

“…Currently, in-hospital costs are higher for PPVI mainly due to the high costs of the stent and valve. If device costs would be reduced in the future, PPVI would be cost-saving even with a device cost of five times that of a surgical valve [ 48 ].…”

Evaluation of Occupational Radiation Dose in Transcatheter Aortic Valve Implantation

“…Many of the patients do not have ICU stay and the total length of stay is minimized, "fast track" policy. A study from our centre has recently demonstrated that the catheter treatment of the pulmonic valve versus open surgery is cost saving, even with a catheter device cost five times the surgical valve (69). Due to better imaging modalities and CT reconstruction, the procedural time has currently been reduced.…”