Butzner Michael, Maron Martin S, Sarocco Phil, Teng Chia-Chen, Stanek Eric, Tan Hiangkiat, Robertson Laura A
Health Economics and Outcomes Research, 350 Oyster Point Blvd, South San Francisco, CA 94080 USA.
J Invasive Cardiol. 2022 Dec;34(12):E866-E872. doi: 10.25270/jic/22.00150. Epub 2022 Oct 26.
Patients with obstructive hypertrophic cardiomyopathy (oHCM) and severe refractory symptoms may require invasive septal reduction therapies (SRTs), either surgical septal myectomy (SM) or transcatheter alcohol septal ablation (ASA). The main objective of this study was to quantify all-cause and oHCM-related healthcare resource utilization (HCRU) and costs for patients receiving SM or ASA.
This retrospective study utilized medical and pharmacy claims submitted during 2012-2020. HCRU and costs for 119 adults with oHCM who had at least 1 SM (n = 95) or ASA (n = 24) were compared for baseline and follow-up periods.
The mean inpatient hospitalization stay was longer for SM (8.3 days) than ASA (6.0 days). Postprocedure HCM-related medication usage was greater following SM (98%) than ASA (88%). The mean number of HCM-related outpatient visits increased from pre- to post procedure (12.2 vs 15.9 in the SM group; 7.2 vs 9.5 in the ASA group), with most patients having at least 1 cardiology visit post procedure (86% of the SM group; 83% of the ASA group). Total mean HCM-related costs (reported in United States currency) increased with both procedures ($27,045 vs $119,772 in the SM group; $11,278 vs $54,351 in the ASA group), driven by increased inpatient hospitalization ($10,325 vs $112,923 in the SM group; $5509 vs $47,450 in the ASA group) and surgical costs ($6665 vs $92,031 in the SM group; $52 vs $44,815 in the ASA group).
Our results indicate increasing costs for patients undergoing SRT, driven by inpatient hospitalizations and surgical costs. Commercially insured and Medicare Advantage patients with oHCM experience high healthcare costs and economic burden attributable to SRT.
患有梗阻性肥厚型心肌病(oHCM)且有严重难治性症状的患者可能需要进行侵入性室间隔减容治疗(SRTs),即外科室间隔心肌切除术(SM)或经导管酒精室间隔消融术(ASA)。本研究的主要目的是量化接受SM或ASA治疗的患者的全因和oHCM相关的医疗资源利用(HCRU)及成本。
这项回顾性研究利用了2012年至2020年期间提交的医疗和药房理赔数据。比较了119例患有oHCM且至少接受过1次SM(n = 95)或ASA(n = 24)治疗的成年人在基线期和随访期的HCRU及成本。
SM组的平均住院天数(8.3天)比ASA组(6.0天)更长。术后与HCM相关的药物使用情况,SM组(98%)高于ASA组(88%)。与HCM相关的门诊就诊平均次数从术前到术后有所增加(SM组为12.2次对15.9次;ASA组为7.2次对9.5次),大多数患者术后至少有1次心脏病就诊(SM组的86%;ASA组的83%)。两种治疗方法的HCM相关总平均成本(以美元报告)均有所增加(SM组为27,045美元对119,772美元;ASA组为11,278美元对54,351美元),这是由住院费用增加(SM组为10,325美元对112,923美元;ASA组为5509美元对47,450美元)和手术费用增加(SM组为6665美元对92,031美元;ASA组为52美元对44,815美元)所驱动。
我们的结果表明,住院费用和手术费用导致接受SRT治疗的患者成本增加。患有oHCM的商业保险和医疗保险优势计划患者因SRT面临高额医疗成本和经济负担。