title: Cost-analysis of percutaneous pulmonary valve implantation compared to surgical pulmonary valve replacement.
abstract: OBJECTIVE
  To perform cost evaluation and economic modeling of percutaneous pulmonary valve implantation (PPVI) compared to surgical revision.
  
  
  BACKGROUND
  While, PPVI appears to be a viable alternative to surgical conduit revision in select patients with right ventricular outflow tract anomalies, its overall economic burden has yet to be determined.
  
  
  RESULTS
  We examined the first 17 patients who underwent PPVI at our institution and compared them with the most-recently placed surgical valves. Economic data were obtained from the actual procedural and in-hospital charges and used as the base estimates for 5- and 10-year future modeling with appropriate sensitivity analysis. Median total hospital and procedural charges incurred by the patient were significantly higher for the surgical valve compared with PPVI ($126,406 ± $38,772 vs. $80,328 ± $17,387, P < 0.001). Median total societal charges were also higher for the surgical valve ($129,519 ± $39,021 vs. $80,939 ± $17,334, P < 0.001) owing to an average wage loss of $3,113 for surgical patients, contrasted to $611 who underwent PPVI, and a shorter length of stay (1.0 ± 0 vs. 5.7 ± 2.2, P <0.001) for PPVI. Sensitivity analysis determined that PPVI would need to fail at a rate of 17% per year (or 93% at 10 years) to lose its cost advantage.
  
  
  CONCLUSIONS
  PPVI holds a significant cost advantage over the surgical approach, fewer hospital days, and incurs less patient wage loss. Furthermore, it would need to have a very high failure rate at 10 years to lose its cost advantage.
authors.affiliation: Division of Pediatric Cardiology, University of Virginia, Charlottesville, Virginia.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Vergales
authors.forename: Tanya
authors.initials: T
authors.lastname: Wanchek
authors.forename: Wendy
authors.initials: W
authors.lastname: Novicoff
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.forename: D Scott
authors.initials: DS
authors.lastname: Lim
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D006350:Heart Valve Prosthesis / Q000191:economics; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D018579:Patient Selection; D011664:Pulmonary Valve / Q000601:surgery*; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits; D018582:Sick Leave / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014768:Virginia; D055815:Young Adult
keywords: congenital heart disease; cost-prediction; transcatheter valve implantation