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Area of Science:

  • Healthcare economics
  • Surgical outcomes research
  • Pediatric cardiology

Background:

  • Assessing resource utilization in congenital heart surgery is critical but methods are debated.
  • Traditional cost-to-charge ratio methods may not accurately reflect actual resources consumed.

Purpose of the Study:

  • To compare traditional cost-to-charge ratio methods with newer standardized cost methods for resource utilization in congenital heart surgery.
  • To evaluate the impact of methodology on assessing resource use variability across hospitals.

Main Methods:

  • Utilized clinical data from The Society of Thoracic Surgeons Database linked with resource use data from Pediatric Health Information Systems Database (2010-2015).
  • Developed and compared standardized cost methods specific to congenital heart surgery with cost-to-charge ratio methods.
  • Employed hierarchical mixed-effect models to analyze resource use and variability, adjusting for case-mix.

Main Results:

  • Included 43 hospitals and 65,331 patients; minimal population-level differences were observed between the two methods.
  • Standardized cost methods showed less apparent variability in resource use across hospitals (CV 20% vs 25%) and complexity categories (STAT).
  • 33% of hospitals changed resource use tertile classification based on the methodology used.

Conclusions:

  • Standardized cost methodology shows minimal differences at the population level but reduced variability at the hospital level in congenital heart surgery.
  • Approximately one-third of centers reclassified their resource use categories, indicating significant methodological impact.
  • Careful selection of methodology is crucial for future studies, benchmarking, and reporting of resource utilization in this population.