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

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.

Informations de copyright

Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Financial support for this research was derived in part from the Kennedy Hamill Pediatric Cardiac Research Fund, the Liam Sexton Foundation, and a Heart Like Ava. Dr O’Byrne received research support from the National Institute of Health/National Heart, Lung, and Blood Institute (K23 HL130420-01). The funding agencies had no role in the planning or execution of the study, nor did they edit the manuscript as presented. The study also used resources from The Children's Hospital of Philadelphia Cardiac Center Clinical Research Core. The manuscript represents the opinions of the authors alone. Dr Glatz has served as a consultant for Ampio Pharmaceuticals. Dr Goldstein has served as a consultant for Medtronic, W.L. Gore & Associates, and Mezzion Pharma; and has served as a consultant and on the advisory board for PECA Labs. Dr Qureshi has served as a consultant for Medtronic, W.L. Gore & Associates, Edwards Lifesciences, and Abiomed. Dr Shahanavaz has served as a consultant for Medtronic, Edwards Lifesciences, W.L Gore & Associates, and Abbott Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.