The cost of treating heart valve related complications.
OBJECTIVE
Heart valve replacement can result in serious complications. Therefore, it is important in decision making regarding the choice of valves to know the cost of such complications.


METHODS
Complications were defined according to guidelines proposed by the Society of Thoracic Surgeons. They included valve thrombosis, embolism, hemorrhage due to anticoagulation, non-structural dysfunction, structural deterioration and endocarditis. The costs of the pre-admission assessment, acute inpatient stay, inpatient physician fees, post-discharge and out-patient physician fees were estimated for each complication to determine the average total cost in 1995 US dollars. Cost inputs were obtained from existing Massachusetts databases and Medicare fee schedules.


RESULTS
The costs of managing valve thrombosis, endocarditis and non-structural dysfunction were all estimated to exceed $30,000 for a single event. The costs of acute management of embolism and anticoagulant-related hemorrhage were between $8,000 and $11,500. However, it is of note that managing the sequelae of an embolism was calculated to be greater than $70,000 over 15 years. The greatest contributor to the average cost of treating a complication was determined to be the in-patient facility cost.


CONCLUSIONS
Complications related to heart valve replacement can be very costly to manage in both the short term and the long term.
Caro
J J
JJ
Caro Research, Concord, MA, USA.
Migliaccio-Walle
K
K
O'Brien
J A
JA
D003365:Costs and Cost Analysis; D004696:Endocarditis / Q000191:economics / Q000209:etiology / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000191:economics*; D006801:Humans; D008404:Massachusetts; D011183:Postoperative Complications / Q000191:economics; D012086:Reoperation; D013927:Thrombosis / Q000191:economics / Q000209:etiology / Q000601:surgery