The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH (B.H.G., A.F., W.W., W.J.W.).
The Cardiac Center at the Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine (M.L.O., D.D., H.M.G., C.E.M., A.C.G.).
Circ Cardiovasc Interv. 2019 Apr;12(4):e007232. doi: 10.1161/CIRCINTERVENTIONS.118.007232.
In infants with ductal-dependent pulmonary blood flow, initial palliation with patent ductus arteriosus (PDA) stent or modified Blalock-Taussig (BT) shunt have comparable mortality but discrepant length of stay, procedural complication rates and reintervention burdens, which may influence cost. The relative economic impact of these palliation strategies is unknown.
Retrospective study of infants with ductal-dependent pulmonary blood flow palliated with PDA stent (n=104) or BT shunt (n=251) from 2008 to 2015 at 4 centers of the Congenital Catheterization Research Collaborative. Inflation-adjusted inpatient hospital costs were calculated for first year of life using Pediatric Health Information System data. Costs derived from outpatient catheterizations not in Pediatric Health Information System were imputed. Costs were compared using propensity score-adjusted multivariable models, to account for baseline differences between groups. After propensity score adjustment, first year of life costs were significantly lower in PDA stent ($215 825 [190 644-244 333]) than BT shunt ($249 855 [230 693-270 609]) patients ( P=0.05). After addition of imputed costs, first year of life costs were not significantly different between PDA stent ($226 403 [200 274-255 941]) and BT shunt ($252 072 [232 955-272 759]) groups ( P=0.15). Patient characteristics associated with higher costs included: younger gestational age, genetic syndrome, noncardiac diagnoses, procedural complications, extracorporeal membrane oxygenation, duration of ventilation, intensive care unit and hospital length of stay and reintervention ( P≤0.02 for all).
In this first multicenter comparative cost study of PDA stent or BT shunt as palliation for infants with ductal-dependent pulmonary blood flow, adjusted for baseline differences, PDA stent was associated with lower to equivalent costs over the first year of life. Combined with previous evidence suggesting clinical noninferiority, these findings suggest that PDA stent provides competitive health care value.
在依赖动脉导管的肺血流的婴儿中，采用动脉导管未闭（PDA）支架或改良的 Blalock-Taussig（BT）分流术进行初始姑息治疗，其死亡率相当，但住院时间、手术并发症发生率和再介入负担存在差异，这可能会影响成本。这些姑息治疗策略的相对经济影响尚不清楚。
对 2008 年至 2015 年期间在先天性导管插入术研究协作组的 4 个中心接受 PDA 支架（n=104）或 BT 分流术（n=251）姑息治疗的依赖动脉导管的肺血流婴儿进行回顾性研究。使用儿科健康信息系统数据计算了生命第一年的膨胀调整后住院医院费用。未纳入儿科健康信息系统的门诊导管治疗费用进行了估算。使用倾向评分调整的多变量模型进行成本比较，以解释组间的基线差异。在倾向评分调整后，PDA 支架组（215825 美元[190644-244333]）的生命第一年成本显著低于 BT 分流术组（249855 美元[230693-270609]）（P=0.05）。在添加估算的成本后，PDA 支架组（226403 美元[200274-255941]）与 BT 分流术组（252072 美元[232955-272759]）的生命第一年成本无显著差异（P=0.15）。与更高成本相关的患者特征包括：胎龄较小、遗传综合征、非心脏诊断、手术并发症、体外膜氧合、通气时间、重症监护病房和住院时间以及再介入（所有 P≤0.02）。
在这项首次对依赖动脉导管的肺血流婴儿的 PDA 支架或 BT 分流术姑息治疗进行的多中心成本比较研究中，在调整了基线差异后，PDA 支架与生命第一年的成本较低或相当。结合先前表明临床非劣效性的证据，这些发现表明 PDA 支架提供了有竞争力的医疗保健价值。
