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Cost of Pacing in Pediatric Patients With Postoperative Heart Block After Congenital Heart Surgery
Abhijit Mondal1,2, Minkyoung Yoo3, Stephanie Tuttle1
1Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
Insights
The number of pediatric congenital heart surgeries (CHSs) and permanent pacemaker (PPM) implantations has risen. PPM implantation incurs significant lifetime costs, highlighting the need to reduce its incidence after CHS.
Area of Science:
- Pediatric Cardiology
- Health Economics
- Biomedical Engineering
Background:
- Congenital heart defect (CHD) surgical correction has improved pediatric survival and quality of life.
- The increasing volume of CHS correlates with a rise in postoperative heart block requiring permanent pacemakers (PPMs).
Purpose of the Study:
- To analyze trends in permanent pacing following CHS in pediatric patients.
- To estimate the economic burden of PPM implantation on patients and families.
Main Methods:
- Economic evaluation using a single-institution database (1960-2018).
- Analysis of patients younger than 4 years requiring PPM post-CHS, with up to 20-year follow-up.
- Cost estimation using Markov model simulation and hospital event charges.
Main Results:
- CHS and PPM implantation rates increased by 2.2% and 7.2% annually, respectively.
- Estimated 20-year costs for PPM implantation in pediatric patients were $180,664 (direct) and $15,939 (indirect).
- Patients with complications faced significantly higher costs: $472,774 (direct) and $36,429 (indirect).
Conclusions:
- PPM implantation in pediatric patients represents a substantial lifetime financial and healthcare burden.
- Reducing the incidence of PPM implantation post-CHS should be a key clinical objective.
Importance:
Surgical correction of congenital heart defects (CHDs) has improved the lifespan and quality of life of pediatric patients. The number of congenital heart surgeries (CHSs) in children has grown continuously since the 1960s. This growth has been accompanied by a rise in the incidence of postoperative heart block requiring permanent pacemaker (PPM) implantation.
Objective:
To assess the trends in permanent pacing after CHS and estimate the economic burden to patients and their families after PPM implantation.
Design, Setting, And Participants:
In this economic evaluation study, procedure- and diagnosis-specific codes within a single-institution database were used to identify patients with postoperative heart block after CHS between January 1, 1960, and December 31, 2018. Patients younger than 4 years with postoperative PPM implantation were selected, and up to 20-year follow-up data were used for cost analysis based on mean hospital event charges and length of stay (LOS) data. Data were analyzed from January 1, 2020, to November 30, 2022.
Exposure:
Implantation of PPM after CHS in pediatric patients.
Main Outcomes And Measures:
Annual trends in CHS and postoperative PPM implantations were assessed. Direct and indirect costs associated with managing conduction health for the 20 years after PPM implantation were estimated using Markov model simulation and patient follow-up data.
Results:
Of the 28 225 patients who underwent CHS, 968 (437 female [45.1%] and 531 male [54.9%]; 468 patients aged <4 years) received a PPM due to postoperative heart block. The rate of CHS and postoperative PPM implantations increased by 2.2% and 7.2% per year between 1960 and 2018, respectively. In pediatric patients younger than 4 years with PPM implantation, the mean (SD) 20-year estimated direct and indirect costs from Markov model simulations were $180 664 ($32 662) and $15 939 ($1916), respectively. Using follow-up data of selected patients with clinical courses involving 1 or more complication events, the mean (SD) direct and indirect costs were $472 774 ($212 095) and $36 429 ($16 706), respectively.
Conclusions And Relevance:
In this economic evaluation study, the cost of PPM implantation in pediatric patients was found to accumulate over the lifespan. This cost may represent not only a substantial financial burden but also a health care burden to patient families. Reducing the incidence of PPM implantation should be a focused goal of CHS.
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