Related Experiment Video
Updated: Apr 12, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects
Michael L O'Byrne1, Matthew J Gillespie2, Russell T Shinohara3
1Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA.
Insights
Transcatheter closure of atrial septal defects (ASDs) is more cost-effective than surgical repair in the short term. Follow-up care significantly impacts the overall cost advantage of transcatheter ASD closure.
Area of Science:
- Cardiology
- Health Economics
Background:
- Clinical outcomes for transcatheter and operative atrial septal defect (ASD) closures are comparable.
- The economic cost-effectiveness of these ASD closure methods requires further elucidation.
Purpose of the Study:
- To compare the inflation-adjusted costs of transcatheter versus operative closure for single secundum ASDs.
- To identify cost drivers and assess the economic impact of reintervention and crossover admissions.
Main Methods:
- Retrospective cohort study of 244 patients (<30 years) undergoing ASD closure.
- Propensity score weight-adjusted multivariate regression analysis in an intention-to-treat framework.
- Inclusion of costs associated with reintervention and crossover admissions.
Main Results:
- Transcatheter closure cost $55,841 (2012 USD) versus $60,992 (2012 USD) for operative closure (P < .001).
- Cost savings for transcatheter closure were driven by shorter length of stay, reduced medication use, and fewer follow-up tests.
- Operative closure had a higher 30-day readmission rate, further favoring transcatheter closure economically.
Conclusions:
- Transcatheter closure offers a short-term cost advantage for single secundum ASDs.
- Follow-up care strategies significantly influence the overall cost-effectiveness of transcatheter ASD closure.
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.
