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Avoidable costs of stenting for aortic coarctation in the United Kingdom: an economic model
Maximilian Salcher1, Alistair Mcguire2, Vivek Muthurangu3
1LSE Health and Social Care, Cowdray House; London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. m.salcher@lse.ac.uk.
Insights
Optimizing stenting for coarctation of the aorta (CoA) could reduce healthcare costs by up to 10%. Improving treatment effectiveness and reducing complications are key to realizing these savings for patients with this congenital heart disease.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Congenital Heart Disease
Background:
- Coarctation of the aorta (CoA) is a common congenital heart defect requiring stenting.
- Post-stenting monitoring is crucial for detecting recurrence and aortic wall injuries.
- The avoidable costs associated with CoA stenting are not well-established.
Purpose of the Study:
- To develop an economic model to estimate potentially avoidable costs of CoA stenting in the UK over 5 years.
- To compare baseline costs with hypothetical scenarios of improved treatment effectiveness and reduced complications.
Main Methods:
- An economic model was created to calculate costs associated with CoA stenting.
- Baseline costs included intervention, complications, and follow-up interventions.
- Costs were compared to scenarios with enhanced treatment success and fewer complications.
Main Results:
- Baseline costs were £16,688 per patient.
- Avoidable costs ranged from £137 to £1,627 per patient.
- Reducing reintervention rates significantly impacts overall costs.
Conclusions:
- Substantial improvements in treatment effectiveness and complication reduction are needed for cost savings.
- Up to 10% of baseline costs could be avoided in optimal scenarios.
- Patient-specific approaches are essential for achieving optimal outcomes in CoA treatment.
Background:
Undesirable outcomes in health care are associated with patient harm and substantial excess costs. Coarctation of the aorta (CoA), one of the most common congenital heart diseases, can be repaired with stenting but requires monitoring and subsequent interventions to detect and treat disease recurrence and aortic wall injuries. Avoidable costs associated with stenting in patients with CoA are unknown.
Methods:
We developed an economic model to calculate potentially avoidable costs in stenting treatment of CoA in the United Kingdom over 5 years. We calculated baseline costs for the intervention and potentially avoidable complications and follow-up interventions and compared these to the costs in hypothetical scenarios with improved treatment effectiveness and complication rates.
Results:
Baseline costs were £16 688 ($25 182) per patient. Avoidable costs ranged from £137 ($207) per patient in a scenario assuming a 10% reduction in aortic wall injuries and reinterventions at follow-up, to £1627 ($2455) in a Best-case scenario with 100% treatment success and no complications. Overall costs in the Best-case scenario were 90.2% of overall costs at Baseline. Reintervention rate at follow-up was identified as most influential lever for overall costs. Probabilistic sensitivity analysis showed a considerable degree of uncertainty for avoidable costs with widely overlapping 95% confidence intervals.
Conclusions:
Significant improvements in the treatment effectiveness and reductions in complication rates are required to realize discernible cost savings. Up to 10% of total baseline costs could be avoided in the best-case scenario. This highlights the need to pursue patient-specific treatment approaches which promise optimal outcomes.