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

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

doi:10.1016/j.jacc.2021.12.036

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

J Am Coll Cardiol. 2022 Mar 29;79(12):1170-1180. doi: 10.1016/j.jacc.2021.12.036.

Authors

Michael L O'Byrne¹, Andrew C Glatz², Yuan-Shung V Huang³, Michael S Kelleman⁴, Christopher J Petit⁵, Athar M Qureshi⁶, Shabana Shahanavaz⁷, George T Nicholson⁸, Shawn Batlivala⁹, Jeffery J Meadows¹⁰, Jeffrey D Zampi¹¹, Mark A Law¹², Jennifer C Romano¹¹, Christopher E Mascio¹³, Paul J Chai⁴, Shiraz Maskatia¹⁴, Ivor B Asztalos¹³, Asaad Beshish⁴, Joelle Pettus⁴, Amy L Pajk⁹, Steven J Healan⁸, Lindsay F Eilers⁶, Taylor Merritt¹⁵, Courtney E McCracken⁴, Bryan H Goldstein¹⁶

Affiliations

¹ Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center For Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: obyrnem@email.chop.edu.
² Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center For Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁴ Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA.
⁵ Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA; Division of Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
⁶ Lillie Frank Abercrombie Section on Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
⁷ Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA; Heart Center, St. Louis Children's Hospital, St. Louis, Missouri, USA.
⁸ Division of Cardiology, Monroe Carrell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
⁹ Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA.
¹⁰ Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.
¹¹ C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA.
¹² Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹³ Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁴ Betty Irene Moore Children's Heart Center, Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA.
¹⁵ Heart Center, St. Louis Children's Hospital, St. Louis, Missouri, USA.
¹⁶ Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA; Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

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.

Keywords: economic analysis; heart catheterization; heart surgery; pediatrics.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Cardiac Surgical Procedures* / adverse effects
Humans
Infant, Newborn
Retrospective Studies
Tetralogy of Fallot* / surgery
Treatment Outcome

Grants and funding

K23 HL130420/HL/NHLBI NIH HHS/United States