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Differences in Cost of Care by Palliation Strategy for Infants with Ductal-Dependent Pulmonary Blood Flow: Analysis of Data from the Congenital Catheterization Research Collaborative Study of Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt
Abstract
Background:
In infants with ductal-dependent pulmonary blood flow (PBF), initial palliation with patent ductus arteriosus (PDA) stent or modified Blalock-Taussig (BT) shunt have comparable mortality but discrepant length of stay (LOS), procedural complication rates and reintervention burdens, which may influence cost. The relative economic impact of these palliation strategies is unknown.
Methods and Results:
Retrospective study of infants with ductal-dependent PBF palliated with PDA stent (n=104) or BT shunt (n=251) from 2008–15 at 4 centers of the Congenital Catheterization Research Collaborative. Inflation-adjusted inpatient hospital costs were calculated for first-year-of-life (FYOL) using Pediatric Health Information System (PHIS) data. Costs derived from outpatient catheterizations not in PHIS were imputed. Costs were compared using propensity score adjusted multivariable models, to account for baseline differences between groups. After propensity score adjustment, FYOL 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). Following addition of imputed costs, FYOL 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, non-cardiac diagnoses, procedural complications, ECMO, duration of ventilation, ICU and hospital LOS and re-intervention (p≤0.02 for all).
Conclusions:
In this first multicenter comparative study of PDA stent or BT shunt as palliation for infants with ductal-dependent PBF, adjusted for baseline differences, PDA stent was associated with lower to equivalent costs over the FYOL. Combined with previous evidence suggesting clinical non-inferiority, these findings suggest that PDA stent provides competitive health care value.