Cumulative In-Hospital Costs Associated With Single-Ventricle Palliation

Michael L O'Byrne; Kimberly E McHugh; Jing Huang; Lihai Song; Heather Griffis; Brett R Anderson; Emily M Bucholz; Nikhil K Chanani; Justin J Elhoff; Stephanie S Handler; Jeffery P Jacobs; Jennifer S Li; Alan B Lewis; Brian W McCrindle; Nelangi M Pinto; Peter Sassalos; David S Spar; Sara K Pasquali; Andrew C Glatz

doi:10.1016/j.jacadv.2022.100029

Cumulative In-Hospital Costs Associated With Single-Ventricle Palliation

JACC Adv. 2022 May 26;1(2):100029. doi: 10.1016/j.jacadv.2022.100029. eCollection 2022 Jun.

Authors

Michael L O'Byrne^{1

2

3}, Kimberly E McHugh⁴, Jing Huang^{1

5}, Lihai Song⁶, Heather Griffis⁶, Brett R Anderson⁷, Emily M Bucholz⁸, Nikhil K Chanani⁹, Justin J Elhoff¹⁰, Stephanie S Handler¹¹, Jeffery P Jacobs¹², Jennifer S Li¹³, Alan B Lewis¹⁴, Brian W McCrindle¹⁵, Nelangi M Pinto¹⁶, Peter Sassalos¹⁷, David S Spar¹⁸, Sara K Pasquali¹⁹, Andrew C Glatz^{1

2}

Affiliations

¹ Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
² Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³ Leonard Davis Institute of Health Economics and Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA.
⁵ Department of Biostatistics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
⁶ Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁷ Division of Cardiology, New York-Presbyterian Morgan-Stanley Children's Hospital/Columbia University Irving Medical Center, New York, New York, USA.
⁸ Department of Cardiology, Children's Hospital Boston and Harvard University Medical School, Boston, Massachusetts, USA.
⁹ Children's Healthcare of Atlanta, Sibley Heart Center and Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁰ Sections of Critical Care and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.
¹¹ Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
¹² Division of Cardiothoracic Surgery, Departments of Surgery and Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida, USA.
¹³ Division of Pediatric Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁴ Division of Cardiology, Department of Pediatrics, Children's Hospital of Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
¹⁵ Department of Pediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁶ Division of Cardiology, Primary Children's Hospital and University of Utah School of Medicine, Salt Lake City, Utah, USA.
¹⁷ Division of Pediatric Cardiothoracic Surgery, C.S. Mott Children's Hospital and University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
¹⁸ The Heart Institute, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA.
¹⁹ Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Abstract

Background: In the SVR (Single Ventricle Reconstruction) Trial, 1-year survival in recipients of right ventricle to pulmonary artery shunts (RVPAS) was superior to that in those receiving modified Blalock-Taussig-Thomas shunts (MBTTS), but not in subsequent follow-up. Cost analysis is an expedient means of evaluating value and morbidity.

Objectives: The purpose of this study was to evaluate differences in cumulative hospital costs between RVPAS and MBTTS.

Methods: Clinical data from SVR and costs from Pediatric Health Information Systems database were combined. Cumulative hospital costs and cost-per-day-alive were compared serially at 1, 3, and 5 years between RVPAS and MBTTS. Potential associations between patient-level factors and cost were explored with multivariable models.

Results: In total, 303 participants (55% of the SVR cohort) from 9 of 15 sites were studied (48% MBTTS). Observed total costs at 1 year were lower for MBTTS ($701,260 ± 442,081) than those for RVPAS ($804,062 ± 615,068), a difference that was not statistically significant (P = 0.10). Total costs were also not significantly different at 3 and 5 years (P = 0.21 and 0.32). Similarly, cost-per-day-alive did not differ significantly for either group at 1, 3, and 5 years (all P > 0.05). In analyses of transplant-free survivors, total costs and cost-per-day-alive were higher for RVPAS at 1 year (P = 0.05 for both) but not at 3 and 5 years (P > 0.05 for all). In multivariable models, aortic atresia and prematurity were associated with increased cost-per-day-alive across follow-up (P < 0.05).

Conclusions: Total costs do not differ significantly between MBTTS and RVPAS. The magnitude of longitudinal costs underscores the importance of efforts to improve outcomes in this vulnerable population.

Keywords: economic analysis; hypoplastic left heart syndrome; outcomes research; pediatrics.