TY - JOUR
T1 - Comparative Costs of Management Strategies for Neonates With Symptomatic Tetralogy of Fallot
AU - O'Byrne, Michael L.
AU - Glatz, Andrew C.
AU - Huang, Yuan shung V.
AU - Kelleman, Michael S.
AU - Petit, Christopher J.
AU - Qureshi, Athar M.
AU - Shahanavaz, Shabana
AU - Nicholson, George T.
AU - Batlivala, Shawn
AU - Meadows, Jeffery J.
AU - Zampi, Jeffrey D.
AU - Law, Mark A.
AU - Romano, Jennifer C.
AU - Mascio, Christopher E.
AU - Chai, Paul J.
AU - Maskatia, Shiraz
AU - Asztalos, Ivor B.
AU - Beshish, Asaad
AU - Pettus, Joelle
AU - Pajk, Amy L.
AU - Healan, Steven J.
AU - Eilers, Lindsay F.
AU - Merritt, Taylor
AU - McCracken, Courtney E.
AU - Goldstein, Bryan H.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/3/29
Y1 - 2022/3/29
N2 - Background: Recent data have demonstrated that overall mortality and adverse events are not significantly different for primary repair (PR) and staged repair (SR) approaches to management of neonates with symptomatic tetralogy of Fallot (sTOF). Cost data can be used to compare the relative value (cost for similar outcomes) of these approaches and are a potentially more sensitive measure of morbidity. Objectives: This study sought to compare the economic costs associated with PR and SR in neonates with sTOF. Methods: Data from a multicenter retrospective cohort study of neonates with sTOF were merged with administrative data to compare total costs and cost per day alive over the first 18 months of life in a propensity score–adjusted analysis. A secondary analysis evaluated differences in department-level costs. Results: In total, 324 subjects from 6 centers from January 2011 to November 2017 were studied (40% PR). The 18-month cumulative mortality (P = 0.18), procedural complications (P = 0.10), hospital complications (P = 0.94), and reinterventions (P = 0.22) did not differ between PR and SR. Total 18-month costs for PR (median $179,494 [IQR: $121,760-$310,721]) were less than for SR (median: $222,799 [IQR: $167,581-$327,113]) (P < 0.001). Cost per day alive (P = 0.005) and department-level costs were also all lower for PR. In propensity score–adjusted analyses, PR was associated with lower total cost (cost ratio: 0.73; P < 0.001) and lower department-level costs. Conclusions: In this multicenter study of neonates with sTOF, PR was associated with lower costs. Given similar overall mortality between treatment strategies, this finding suggests that PR provides superior value.
AB - Background: Recent data have demonstrated that overall mortality and adverse events are not significantly different for primary repair (PR) and staged repair (SR) approaches to management of neonates with symptomatic tetralogy of Fallot (sTOF). Cost data can be used to compare the relative value (cost for similar outcomes) of these approaches and are a potentially more sensitive measure of morbidity. Objectives: This study sought to compare the economic costs associated with PR and SR in neonates with sTOF. Methods: Data from a multicenter retrospective cohort study of neonates with sTOF were merged with administrative data to compare total costs and cost per day alive over the first 18 months of life in a propensity score–adjusted analysis. A secondary analysis evaluated differences in department-level costs. Results: In total, 324 subjects from 6 centers from January 2011 to November 2017 were studied (40% PR). The 18-month cumulative mortality (P = 0.18), procedural complications (P = 0.10), hospital complications (P = 0.94), and reinterventions (P = 0.22) did not differ between PR and SR. Total 18-month costs for PR (median $179,494 [IQR: $121,760-$310,721]) were less than for SR (median: $222,799 [IQR: $167,581-$327,113]) (P < 0.001). Cost per day alive (P = 0.005) and department-level costs were also all lower for PR. In propensity score–adjusted analyses, PR was associated with lower total cost (cost ratio: 0.73; P < 0.001) and lower department-level costs. Conclusions: In this multicenter study of neonates with sTOF, PR was associated with lower costs. Given similar overall mortality between treatment strategies, this finding suggests that PR provides superior value.
KW - economic analysis
KW - heart catheterization
KW - heart surgery
KW - pediatrics
UR - http://www.scopus.com/inward/record.url?scp=85126286022&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2021.12.036
DO - 10.1016/j.jacc.2021.12.036
M3 - Article
C2 - 35331412
AN - SCOPUS:85126286022
SN - 0735-1097
VL - 79
SP - 1170
EP - 1180
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 12
ER -