Rising charges and costs for pediatric catheter ablation.
BACKGROUND
Catheter ablation has been shown to be effective for pediatric tachyarrhythmias, but the associated charges and costs have not been described in the recent era. Understanding such contemporary trends may identify ways to keep an effective therapy affordable while optimizing clinical outcomes.


METHODS
We used the 1997-2009 Kids' Inpatient Databases to examine trends in charges and costs for pediatric catheter ablation and identify determinants of temporal changes.


RESULTS
There were 7,130 discharges for catheter ablation in the sample. Mean age at ablation was 12.1 ± 0.2 years. Patients with congenital heart disease (CHD) made up 10% of the sample. Complications occurred in 8% of discharges. Mean total charges rose 219% above inflation (from $23,798 ± 1,072 in 1997 to $75,831 ± 2,065 in 2009). From 2003 to 2009, costs rose 25% (from $20,459 ± 780 in 2003 to $25,628 ± 992 in 2009). Charges for ablation increased markedly relative to surgical procedures, but with a similar slope to other catheter-based interventions. Multivariable analysis revealed that year (P < 0.0001), payer (P = 0.0002), CHD (P < 0.0001), valvular heart disease (P = 0.0004), cardiomyopathy (P = 0.0009), hospital region (P < 0.0001), length of stay (P < 0.0001), and complications (P < 0.0001) predicted increased charges. The same factors also predicted increased costs. Charges and costs varied considerably by region, particularly for high-volume centers (P < 0.0001).


CONCLUSIONS
Charges and costs for pediatric catheter ablation increased relative to other procedures and significantly outstripped inflation. Further study of complications, length of stay, and regional differences may help control rising costs while maintaining quality of care.
Heart Development and Structural Diseases Branch/Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA. kristin.burns@nih.gov
Kristin M
KM
Burns
Frank
F
Evans
Gail D
GD
Pearson
Charles I
CI
Berul
Jonathan R
JR
Kaltman
D001145:Arrhythmias, Cardiac / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics* / Q000706:statistics & numerical data; D002648:Child; D005249:Fees and Charges / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000191:economics*; D015995:Prevalence; D014481:United States / Q000453:epidemiology