Heart Development and Structural Diseases Branch/Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
J Cardiovasc Electrophysiol. 2013 Feb;24(2):162-9. doi: 10.1111/j.1540-8167.2012.02446.x. Epub 2012 Oct 15.
Catheter ablation has been shown to be effective for pediatric tachyarrhythmias, but the associated charges and costs have not been described in the recent era. Understanding such contemporary trends may identify ways to keep an effective therapy affordable while optimizing clinical outcomes.
We used the 1997-2009 Kids' Inpatient Databases to examine trends in charges and costs for pediatric catheter ablation and identify determinants of temporal changes.
There were 7,130 discharges for catheter ablation in the sample. Mean age at ablation was 12.1 ± 0.2 years. Patients with congenital heart disease (CHD) made up 10% of the sample. Complications occurred in 8% of discharges. Mean total charges rose 219% above inflation (from $23,798 ± 1,072 in 1997 to $75,831 ± 2,065 in 2009). From 2003 to 2009, costs rose 25% (from $20,459 ± 780 in 2003 to $25,628 ± 992 in 2009). Charges for ablation increased markedly relative to surgical procedures, but with a similar slope to other catheter-based interventions. Multivariable analysis revealed that year (P < 0.0001), payer (P = 0.0002), CHD (P < 0.0001), valvular heart disease (P = 0.0004), cardiomyopathy (P = 0.0009), hospital region (P < 0.0001), length of stay (P < 0.0001), and complications (P < 0.0001) predicted increased charges. The same factors also predicted increased costs. Charges and costs varied considerably by region, particularly for high-volume centers (P < 0.0001).
Charges and costs for pediatric catheter ablation increased relative to other procedures and significantly outstripped inflation. Further study of complications, length of stay, and regional differences may help control rising costs while maintaining quality of care.
导管消融术已被证明对儿科心动过速有效，但在最近的时代，尚未描述相关的费用和成本。了解这种当代趋势可能会找到保持有效治疗负担得起的方法，同时优化临床结果。
我们使用 1997 年至 2009 年的儿童住院数据库，研究了儿科导管消融术费用和成本的趋势，并确定了时间变化的决定因素。
在样本中，有 7130 例导管消融术出院。消融时的平均年龄为 12.1 ± 0.2 岁。患有先天性心脏病（CHD）的患者占样本的 10％。并发症发生在 8％的出院病例中。总费用比通货膨胀高出 219％（从 1997 年的 23798 ± 1072 美元增加到 2009 年的 75831 ± 2065 美元）。从 2003 年到 2009 年，成本增长了 25％（从 2003 年的 20459 ± 780 美元增加到 2009 年的 25628 ± 992 美元）。消融的费用相对于手术程序显着增加，但与其他基于导管的介入治疗的斜率相似。多变量分析显示，年份（P <0.0001），付款人（P = 0.0002），先天性心脏病（P <0.0001），瓣膜性心脏病（P = 0.0004），心肌病（P = 0.0009），医院区域（P <0.0001），住院时间（P <0.0001）和并发症（P <0.0001）预测费用增加。同样的因素也预测了成本的增加。费用和成本因地区而异，特别是对于高容量中心（P <0.0001）。
儿科导管消融术的费用和成本相对于其他手术程序增加，并且大大超过了通货膨胀。进一步研究并发症，住院时间和区域差异可能有助于在保持护理质量的同时控制成本上升。
