Kim Jeffrey J, Hijazi Ziyad M
Section of Pediatric Cardiology, Department of Pediatrics, University of Chicago Children's Hospital and Pritzker School of Medicine, Chicago, IL 60637, USA.
Med Sci Monit. 2002 Dec;8(12):CR787-91.
Transcatheter implantation of the Amplatzer septal occluder (ASO) is an alternative to conventional surgical closure of isolated secundum atrial septal defects (ASDs). Neither the clinical outcomes nor the costs of these procedures have been extensively compared.
MATERIAL/METHODS: We performed a retrospective cohort study to evaluate cost-effectiveness in patients with secundum ASDs who underwent closure using either placement of an ASO or surgery. We utilized available TSI accounting data to estimate hospital costs.
On the basis of trans-thoracic echocardiography, the procedures resulted in successful closure of the ASDs in 95.8% of patients in whom the ASO was implanted and 96.8% of surgical patients. Although there were no deaths in either group, complications occurred in 10.4% of patients in whom the ASO was implanted and 31.2% of surgical patients. The mean estimated cost per case treated with the ASO was $11,541 as compared with $21,780 for surgery. The average length of hospital stay per case treated with the ASO was 1.0 day as compared with 4.3 days for surgery. Sensitivity analyses based on our data identified no plausible situations in which the costs of surgery and of implantation of the ASO would be equal.
The equally effective and less costly Amplatzer Septal Occluder appears superior to surgical closure of isolated secundum ASDs in qualifying patients. The transcatheter method is also associated with significantly lower morbidity. Consequently, our results support the use of the ASO as an alternative to surgery for the management of this common congenital lesion.
经导管植入Amplatzer房间隔封堵器（ASO）是孤立性继发孔型房间隔缺损（ASD）传统手术闭合的一种替代方法。这些手术的临床结果和成本尚未得到广泛比较。
材料/方法：我们进行了一项回顾性队列研究，以评估接受ASO植入或手术闭合的继发孔型ASD患者的成本效益。我们利用现有的TSI会计数据来估计医院成本。
根据经胸超声心动图，ASO植入患者中有95.8%、手术患者中有96.8%的ASD成功闭合。虽然两组均无死亡病例，但ASO植入患者中有10.4%、手术患者中有31.2%发生并发症。ASO治疗的平均每例估计成本为11,541美元，而手术为21,780美元。ASO治疗的平均住院时间为1.0天，而手术为4.3天。基于我们的数据进行的敏感性分析未发现手术和ASO植入成本相等的确切情况。
在符合条件的患者中，同样有效且成本更低的Amplatzer房间隔封堵器似乎优于孤立性继发孔型ASD的手术闭合。经导管方法的发病率也显著更低。因此，我们的结果支持使用ASO作为治疗这种常见先天性病变的手术替代方法。
