Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-23T09:04:25.942Z Has data issue: false hasContentIssue false
  • English
  • Français

Economic implications of outpatient cardiac catheterisation in infants with single ventricle congenital heart disease

Published online by Cambridge University Press:  26 June 2019

Jamie N. Colombo ,
Michael R. Hainstock ,
Michael C. Spaeder  and
Jeffery E. Vergales
Jamie N. Colombo*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of VirginiaChildren’s Hospital, 1215 Lee Street, Charlottesville, VA 22903, USA
Michael R. Hainstock
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of VirginiaChildren’s Hospital, 1215 Lee Street, Charlottesville, VA 22903, USA
Michael C. Spaeder
Affiliation:
Department of Pediatrics, Division of Pediatric Critical Care, University of VirginiaChildren’s Hospital, 1215 Lee Street, Charlottesville, VA 22903, USA
Jeffery E. Vergales
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of VirginiaChildren’s Hospital, 1215 Lee Street, Charlottesville, VA 22903, USA
*
Author for correspondence: Jamie N. Colombo, DO, Banner University Medical Center, 1501 N. Campbell Ave., Tucson, AZ 85724, USA. Tel: 520-626-5585; Fax: 520-694-9963; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Resource utilisation for infants with single ventricle CHD remains high without well-studied ways to decrease economic burden. Same-day discharge following cardiac catheterisation has been shown to be safe and effective in children with CHD, but those with single ventricle physiology are commonly excluded. The purpose of this study was to investigate the economic implications of planned same-day discharge following cardiac catheterisation versus universal overnight hospital admission in infants with single ventricle CHD.

Methods and Results:

A probabilistic decision-tree analysis with sensitivity analyses was performed. All included patients were categorised into four possible outcomes; discharge, readmission following discharge (within 48 hours), observation and prolonged hospitalisation. Baseline probabilities of each node of the tree were then combined with the cost data to evaluate the comparative dominance of one decision (immediately discharge) versus the other decision (routinely admit). Patients discharged on the same day as the procedure accrued the lowest attributed hospital cost ($5469), while patients readmitted to the hospital had the highest attributed cost ($11,851). Currently, no other studies have assessed the cost of hospitalisation following cardiac catheterisation in this population. Thus, we allowed for a wide range of cost variation, but same-day discharge dominated the decision outcome with a lower economic burden.

Conclusion:

Same-day discharge following routine cardiac catheterisation in patients with single ventricle physiology is less costly compared to universal overnight admission. This demonstrates an important cost-limiting step in a complex population of patients who have high resource utilisation.

Keywords

Single ventricle CHDcardiac catheterisationcost analysis
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 7 , July 2019 , pp. 960 - 966
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Czosek, RJ, Anderson, JB, Heaton, PC, Cassedy, A, Schnell, B, Cnota, JF. Staged palliation of hypoplastic left heart syndrome: trends in mortality, cost, and length of stay using a national database from 2000 through 2009. Am J Cardiol 2013; 111: 1792–1799. doi:10.1016/j.amjcard.2013.02.039.CrossRefGoogle ScholarPubMed
Brown, DW, Mangeot, C, Anderson, JB, et al. Digoxin use is associated with reduced interstage mortality in patients with no history of arrhythmia after stage I palliation for single ventricle heart disease. J Am Heart Assoc 2016; 5: e002376. doi:10.1161/JAHA.115.002376.CrossRefGoogle Scholar
Oster, ME, Kelleman, M, McCracken, C, Ohye, RG, Mahle, WT. Association of digoxin with interstage mortality: results from the pediatric heart network single ventricle reconstruction trial public use dataset. J Am Heart Assoc 2016; 5: e002566. doi:10.1161/JAHA.115.002566.CrossRefGoogle ScholarPubMed
Dean, PN, Hillman, DG, McHugh, KE, Gutgesell, HP. Inpatient costs and charges for surgical treatment of hypoplastic left heart syndrome. Pediatrics 2011; 128: e1181–1186. doi:10.1542/peds.2010-3742.CrossRefGoogle ScholarPubMed
Arpagaus, M, Gray, D, Zierler, B. Cardiac catheterization in children as outpatients: potential, eligibility, safety and costs. Cardiol Young 2003; 13: 275–283. doi:10.1017/S1047951103000532.CrossRefGoogle ScholarPubMed
Lee, JC, Bengtson, JR, Lipscomb, J, et al. Feasibility and cost-saving potential of outpatient cardiac catheterization. J Am Coll Cardiol 1990; 15: 378–384. doi:10.1016/S0735-1097(10)80066-X.CrossRefGoogle ScholarPubMed
Block, PC, Ockene, I, Goldberg, RJ, et al. A prospective randomized trial of outpatient versus inpatient cardiac catheterization. N Engl J Med 1988; 319: 1251–1255. doi:10.1056/NEJM198811103191904.CrossRefGoogle ScholarPubMed
Cumming, GR. Cardiac catheterization in infants and children. Am J Cardiol 1982; 49: 1248–1253.CrossRefGoogle ScholarPubMed
Colombo, JN, Spaeder, MC, Hainstock, MR. Safety of outpatient cardiac catheterization in infants with single ventricle congenital heart disease. Cardiology in the Young 2018; 28: 1444–1451. doi:10.1017/S1047951118001567.CrossRefGoogle Scholar
Sanders, GD, Neumann, PJ, Basu, A, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA 2016; 316: 1093–1103. doi:10.1001/jama.2016.12195.CrossRefGoogle ScholarPubMed
Gordon, BM, Rodriguez, S, Lee, M, Chang, RK. Decreasing number of deaths of infants with hypoplastic left heart syndrome. J Pediatr 2008; 153: 354–358. doi:10.1016/j.jpeds.2008.03.009.CrossRefGoogle ScholarPubMed
Waldman, JD, Young, TS, Pappelbaum, SJ, et al. Pediatric cardiac catheterization with same-day discharge. American Journal of Cardiology 1982; 50: 800–803.CrossRefGoogle ScholarPubMed
Djulbegovic, B, Elqayam, S. Many faces of rationality: implications of the great rationality debate for clinical decision-making. J Eval Clin Pract 2017; 23: 915–922. doi:10.1111/jep.12788.CrossRefGoogle ScholarPubMed
Cassel, CK, Guest, JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA 2012; 307: 1801–1802. doi:10.1001/jama.2012.476.CrossRefGoogle ScholarPubMed
Berwick, DM, Hackbarth, AD. Eliminating waste in US health care. JAMA 2012; 307: 1513–1516. doi:10.1001/jama.2012.362.Google ScholarPubMed