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Differences in Cost of Care by Palliation Strategy for Infants With Ductal-Dependent Pulmonary Blood Flow
Bryan H Goldstein1, Michael L O'Byrne2, Christopher J Petit3
1The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH (B.H.G., A.F., W.W., W.J.W.).
Insights
For infants needing pulmonary blood flow support, patent ductus arteriosus (PDA) stents and modified Blalock-Taussig (BT) shunts have similar outcomes. PDA stents may offer better healthcare value due to comparable or lower costs.
Area of Science:
- Pediatric Cardiology
- Health Economics
- Congenital Heart Disease
Background:
- Infants with ductal-dependent pulmonary blood flow often require initial palliation.
- Patent ductus arteriosus (PDA) stents and modified Blalock-Taussig (BT) shunts are common palliative strategies.
- While mortality is comparable, differences in length of stay, complications, and reinterventions suggest potential cost variations.
Purpose of the Study:
- To compare the economic impact of PDA stent versus BT shunt palliation in infants with ductal-dependent pulmonary blood flow.
- To determine which palliative strategy offers better healthcare value in the first year of life.
Main Methods:
- Retrospective analysis of 104 PDA stent and 251 BT shunt patients from 2008-2015 across four centers.
- Calculation of inpatient hospital costs for the first year of life using Pediatric Health Information System data.
- Imputation of outpatient catheterization costs and use of propensity score-adjusted multivariable models to control for baseline differences.
Main Results:
- After propensity score adjustment, first-year costs were significantly lower for PDA stent patients ($215,825) compared to BT shunt patients ($249,855) (P=0.05).
- When imputed outpatient costs were included, the cost difference between PDA stent ($226,403) and BT shunt ($252,072) was not statistically significant (P=0.15).
- Factors associated with higher costs included younger gestational age, genetic syndromes, noncardiac diagnoses, complications, ECMO, prolonged ventilation, and longer ICU/hospital stays.
Conclusions:
- PDA stent palliation is associated with lower to equivalent healthcare costs in the first year of life for infants with ductal-dependent pulmonary blood flow, after adjusting for baseline differences.
- Combined with evidence of clinical noninferiority, PDA stenting presents a competitive healthcare value proposition.
- These findings support PDA stenting as a cost-effective initial palliative strategy.
Background:
In infants with ductal-dependent pulmonary blood flow, initial palliation with patent ductus arteriosus (PDA) stent or modified Blalock-Taussig (BT) shunt have comparable mortality but discrepant length of stay, procedural complication rates and reintervention burdens, which may influence cost. The relative economic impact of these palliation strategies is unknown.
Methods And Results:
Retrospective study of infants with ductal-dependent pulmonary blood flow palliated with PDA stent (n=104) or BT shunt (n=251) from 2008 to 2015 at 4 centers of the Congenital Catheterization Research Collaborative. Inflation-adjusted inpatient hospital costs were calculated for first year of life using Pediatric Health Information System data. Costs derived from outpatient catheterizations not in Pediatric Health Information System were imputed. Costs were compared using propensity score-adjusted multivariable models, to account for baseline differences between groups. After propensity score adjustment, first year of life costs were significantly lower in PDA stent ($215 825 [190 644-244 333]) than BT shunt ($249 855 [230 693-270 609]) patients ( P=0.05). After addition of imputed costs, first year of life costs were not significantly different between PDA stent ($226 403 [200 274-255 941]) and BT shunt ($252 072 [232 955-272 759]) groups ( P=0.15). Patient characteristics associated with higher costs included: younger gestational age, genetic syndrome, noncardiac diagnoses, procedural complications, extracorporeal membrane oxygenation, duration of ventilation, intensive care unit and hospital length of stay and reintervention ( P≤0.02 for all).
Conclusions:
In this first multicenter comparative cost study of PDA stent or BT shunt as palliation for infants with ductal-dependent pulmonary blood flow, adjusted for baseline differences, PDA stent was associated with lower to equivalent costs over the first year of life. Combined with previous evidence suggesting clinical noninferiority, these findings suggest that PDA stent provides competitive health care value.
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