Comparative Costs of Management Strategies for Neonates With Symptomatic Tetralogy of Fallot

Authors

Michael L O'Byrne
Andrew C Glatz
Yuan-Shung V Huang
Michael S Kelleman
Christopher J Petit
Athar M Qureshi
Shabana Shahanavaz
George T Nicholson
Shawn Batlivala
Jeffery J Meadows
Jeffrey D Zampi
Mark A Law
Jennifer C Romano
Christopher E Mascio
Paul J Chai
Shiraz Maskatia
Ivor B Asztalos
Asaad Beshish
Joelle Pettus
Amy L Pajk
Steven J Healan
Lindsay F Eilers
Taylor Merritt
Courtney E McCracken
Bryan H Goldstein

Publication Date

3-29-2022

Journal

Journal of the American College of Cardiology

DOI

10.1016/j.jacc.2021.12.036

PMID

33632484

PMCID

PMC8887694

PubMedCentral® Posted Date

3-2-2022

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Cardiac Surgical Procedures, Humans, Infant, Newborn, Retrospective Studies, Tetralogy of Fallot, Treatment Outcome, Pediatrics, heart catheterization, economic analysis, heart surgery

Abstract

BACKGROUND: Recent data have demonstrated that overall mortality and adverse events are not significantly different for primary repair (PR) and staged repair (SR) approaches to management of neonates with symptomatic tetralogy of Fallot (sTOF). Cost data can be used to compare the relative value (cost for similar outcomes) of these approaches and are a potentially more sensitive measure of morbidity.

OBJECTIVES: This study sought to compare the economic costs associated with PR and SR in neonates with sTOF.

METHODS: Data from a multicenter retrospective cohort study of neonates with sTOF were merged with administrative data to compare total costs and cost per day alive over the first 18 months of life in a propensity score-adjusted analysis. A secondary analysis evaluated differences in department-level costs.

RESULTS: In total, 324 subjects from 6 centers from January 2011 to November 2017 were studied (40% PR). The 18-month cumulative mortality (P = 0.18), procedural complications (P = 0.10), hospital complications (P = 0.94), and reinterventions (P = 0.22) did not differ between PR and SR. Total 18-month costs for PR (median $179,494 [IQR: $121,760-$310,721]) were less than for SR (median: $222,799 [IQR: $167,581-$327,113]) (P < 0.001). Cost per day alive (P = 0.005) and department-level costs were also all lower for PR. In propensity score-adjusted analyses, PR was associated with lower total cost (cost ratio: 0.73; P < 0.001) and lower department-level costs.

CONCLUSIONS: In this multicenter study of neonates with sTOF, PR was associated with lower costs. Given similar overall mortality between treatment strategies, this finding suggests that PR provides superior value.