Incremental Cost-Effectiveness of Surgical vs. Percutaneous Treatment of Patent Ductus Arteriosus with the Amplatzer™ Duct Occluder in Children: A Systematic Review

Abstract

Background: Patent ductus arteriosus (PDA) is a relatively common congenital heart disease and the alternatives for the treatment of PDA > 2.5 mm are surgery or percutaneous occlusion with plugs. The latter, although considered the method of choice, are not provided by the Brazilian National Health System (Sistema Único de Saúde -SUS). Our objective was to compare the incremental cost-effectiveness ratio (ICER) of both strategies. Methods: Systematic review of clinical outcomes and development of a decision-making algorithm to evaluate the ICER of Amplatzer™ Duct Occluder (ADO) vs. surgical treatment for the closure of PDA. Costs for both methods were calculated based on the reimbursement figures paid by the SUS in 2010 and the cost of the percutaneous kit (device + support materials) was estimated at R$ 10,000.00. We used as a threshold the willingness to pay the equivalent of three times the Brazilian Gross Domestic Product, i.e., R$ 57,000.00 per year of life saved. Results: Both techniques were safe and effective with less morbidity and shorter hospitalization time for percutaneous closure. Adjusted life expectancy was similar in both groups, and slightly better for the ADO group. Total cost was calculated as R$ 8,507 for surgery and R$ 11,000.00 for ADO. ICER was calculated as R$ 71,380.00 per year of life saved. A threshold analysis showed that a reduction of R$ 492.65 in the cost of the ADO kit would reduce the ICER to an acceptable value for the incorporation of this technology by the SUS. Conclusions: Percutaneous occlusion was associated with less morbidity and shorter hospital stay with similar incremental effectiveness when compared to the surgical treatment. With the direct costs used in this study and considering that the entire population with PDA is treated with the ADO, percutaneous occlusion was less cost-effective. However, a slight reduction in the costs of the percutaneous Introdução: A persistência do canal arterial (PCA) é uma cardiopatia congênita relativamente comum e as alternativas para o tratamento de canais > 2,5 mm são a cirurgia ou a oclusão percutânea com próteses do tipo rolha. Essas últimas, apesar de consideradas o método de escolha, não estão previstas pelo Sistema Único de Saúde (SUS). Nosso objetivo foi comparar a razão de custo-efetividade incremental (RCEI) de ambas as estratégias. Métodos: Revisão sistemática em relação a desfechos clínicos e criação de modelo de decisão para avaliação da RCEI do Amplatzer ® Duct Occluder (ADO) em comparação ao tratamento cirúrgico, para o fechamento da PCA. Os custos para ambos os métodos foram aqueles reembolsados pelo SUS em 2010, e o custo do conjunto (dispositivo + materiais de apoio) foi estimado em R$ 10.000,00. Foi considerado como limiar uma disposição para pagar equivalente a três vezes o Produto Interno Bruto brasileiro, resultando em R$ 57.000,00 por ano de vida salvo. Resultados: As duas técnicas foram seguras e eficazes, com menor morbidade e tempo de internação no fechamento percutâneo. A expectativa de vida ajustada foi sim...

Comparison of Effectiveness and Cost of Patent Ductus Arteriosus Device Occlusion versus Surgical Ligation of Patent Ductus Arteriosus

“…1 The persistence of blood flow through this channel after this age is a defect, which is responsible for 7-11% of all congenital cardiac defects. 2 , 3 The incidence reaches to 80% in premature neonates having weight less than 1.2 kg 1 . Persistence of Patent Ductus Arteriosus (PDA) generates a picture of pulmonary over-circulation, which intern results in congestive Cardiac failure with low weight gain and repeated pulmonary infections and in the long run pulmonary arterial hypertension.…”

Cost-effectiveness analysis of different devices used for the closure of small-to-medium-sized patent ductus arteriosus in pediatric patients

“…[1] Furthermore, the CE ratio and the ICER were calculated again considering the complications as factors affecting the quality of well-being (QWB) of the patients in the short-term to calculate the QALY gained. Values for the QWB were obtained from the QWB scores for PDA closure by Gray and Weinstein.…”

“…Currently, medical cost-effectiveness (CE) studies integrate the cost of treatment and measurements of changes in health-related quality of life after medical intervention and years of life (YOL) gained to estimate the cost of a quality-adjusted life-year (QALY). [1] Over the past four decades, a number of coils/devices have been used for the percutaneous closure of patent ductus arteriosus (PDA)[2] with satisfactory results and minimal complications. [3] To date, the most efficacious and cost effective closure device has not been determined.…”