Center-Related Variation in Hospitalization Cost for Patients Undergoing Percutaneous Left Atrial Appendage Occlusion

Area of Science:

• Cardiovascular Interventions
• Health Economics
• Medical Device Technology

Background:

• Percutaneous left atrial appendage occlusion using the Watchman device is increasingly utilized in the U.S.
• Understanding cost variations is crucial for optimizing healthcare resource allocation.

Purpose of the Study:

• To assess center-specific variations in total hospital costs for Watchman device implantation.
• To identify factors contributing to high hospitalization costs nationally.

Main Methods:

• Analysis of the 2016-2018 National Inpatient Database for adult patients undergoing elective Watchman procedures.
• Utilized mixed-effects models to evaluate center impact on costs, adjusting for patient and center characteristics and length of stay.

Main Results:

• A total of 30,175 patients had Watchman implantation with a median cost of $24,500, showing substantial inter-admission variability.
• Approximately 13% of cost variability was linked to the performing center, not patient-specific factors.
• Higher-volume centers exhibited lower costs and reduced cost variation. Low procedural volume, complications, congestive heart failure, and longer length of stay predicted higher costs.

Conclusions:

• Center-performing the procedure significantly contributes to the variation in total hospital costs for Watchman implantation.
• Addressing center-related cost variability is essential for achieving high-quality, value-based care in Watchman procedures.