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

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 simil...

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Published in:Journal of the American College of Cardiology 2022-03, Vol.79 (12), p.1170-1180
Main Authors: O’Byrne, Michael L., Glatz, Andrew C., Huang, Yuan-shung V., Kelleman, Michael S., Petit, Christopher J., Qureshi, Athar M., Shahanavaz, Shabana, Nicholson, George T., Batlivala, Shawn, Meadows, Jeffery J., Zampi, Jeffrey D., Law, Mark A., Romano, Jennifer C., Mascio, Christopher E., Chai, Paul J., Maskatia, Shiraz, Asztalos, Ivor B., Beshish, Asaad, Pettus, Joelle, Pajk, Amy L., Healan, Steven J., Eilers, Lindsay F., Merritt, Taylor, McCracken, Courtney E., Goldstein, Bryan H.
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creator O’Byrne, Michael L.
Glatz, Andrew C.
Huang, Yuan-shung V.
Kelleman, Michael S.
Petit, Christopher J.
Qureshi, Athar M.
Shahanavaz, Shabana
Nicholson, George T.
Batlivala, Shawn
Meadows, Jeffery J.
Zampi, Jeffrey D.
Law, Mark A.
Romano, Jennifer C.
Mascio, Christopher E.
Chai, Paul J.
Maskatia, Shiraz
Asztalos, Ivor B.
Beshish, Asaad
Pettus, Joelle
Pajk, Amy L.
Healan, Steven J.
Eilers, Lindsay F.
Merritt, Taylor
McCracken, Courtney E.
Goldstein, Bryan H.
description 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. This study sought to compare the economic costs associated with PR and SR in neonates with sTOF. 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. 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. 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. [Display omitted]
doi_str_mv 10.1016/j.jacc.2021.12.036
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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 &lt; 0.001) and lower department-level costs. 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. 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subjects Cardiac Surgical Procedures - adverse effects
economic analysis
heart catheterization
heart surgery
Humans
Infant, Newborn
pediatrics
Retrospective Studies
Tetralogy of Fallot - surgery
Treatment Outcome
title Comparative Costs of Management Strategies for Neonates With Symptomatic Tetralogy of Fallot
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