Willems Ruben, Tack Philip, François Katrien, Annemans Lieven
1 Department of Public Health, Ghent University, Ghent, Belgium.
2 Department of Innovation, Entrepreneurship and Service Management, Ghent University, Ghent, Belgium.
World J Pediatr Congenit Heart Surg. 2019 Jan;10(1):28-36. doi: 10.1177/2150135118808747.
The recent trend to optimize the efficiency of health-care systems requires objective clinical and economic data. European data on the cost of surgical procedures to repair or palliate congenital heart disease in pediatric patients are lacking.
A single-center study was conducted. Bootstrap analysis of variance and bootstrap independent t test assessed the excess direct medical costs associated with minor and major complications in nine surgical procedure types, from a health-care payer perspective. Generalized linear models with log-link function and inverse Gaussian family were used to determine associated covariates with the total hospitalization cost. Descriptive statistics show the repartition between out-of-pocket expenditures and reimbursed costs.
Four hundred thirty-seven patients were included. Mean hospitalization costs ranged from €11,106 (atrial septal defect repair) to €33,865 (Norwood operation). Operations with major complications yielded excess costs compared to operations with no complications, ranging from €7,105 (+65.2%) for a truncus arteriosus repair to €27,438 (+251.7%) for a tetralogy of Fallot repair. Differences in costs were limited between operations with minor versus no complications. Age at procedure, intensive care unit stay, procedure risk category, reintervention, and postoperative mechanical circulatory support were associated with higher total hospitalization costs. Out-of-pocket expenditures represented 6% of total hospitalization costs.
Operations with major complications yield excess costs, compared to operations with minor or no complications. Cost data and attribution are important to improve clinical practice in a cost-effective manner. The health-care system benefits from strategies and technological advancements that have an impact on modifiable cost-affecting parameters.
近期优化医疗保健系统效率的趋势需要客观的临床和经济数据。欧洲缺乏关于小儿患者先天性心脏病修复或姑息手术费用的数据。
开展了一项单中心研究。从医疗保健支付方的角度，采用方差的自抽样分析和独立样本自抽样t检验评估了9种手术类型中与轻微和严重并发症相关的额外直接医疗费用。使用具有对数链接函数和逆高斯族的广义线性模型来确定与总住院费用相关的协变量。描述性统计显示了自付费用和报销费用之间的分配情况。
纳入了437例患者。平均住院费用从11,106欧元（房间隔缺损修复术）到33,865欧元（诺伍德手术）不等。与无并发症的手术相比，有严重并发症的手术产生了额外费用，从动脉干修复术的7,105欧元（增加65.2%）到法洛四联症修复术的27,438欧元（增加251.7%）不等。轻微并发症手术与无并发症手术之间的费用差异有限。手术时的年龄、重症监护病房停留时间、手术风险类别、再次干预以及术后机械循环支持与更高的总住院费用相关。自付费用占总住院费用的6%。
与轻微或无并发症的手术相比，有严重并发症的手术会产生额外费用。成本数据和归因对于以具有成本效益的方式改善临床实践很重要。医疗保健系统受益于对可改变成本影响参数有影响的策略和技术进步。
