title: Incremental cost-effectiveness of percutaneous versus surgical closure of atrial septal defects in children under a public health system perspective in Brazil.
abstract: BACKGROUND
  Cost-effectiveness (CE) studies of percutaneous (PC) versus surgical (SC) atrial septal defect closure are lacking.
  
  
  METHODS
  A systematic literature review in children and a CE analysis based on a model of long-term outcomes were performed. Direct costs of PC and SC were US$8700 (defined arbitrarily) and US$5700 (actually paid), respectively. Three-times the Brazilian GDI (US$28,700) per year of life saved (with a discount rate of 5%) was used as a limit for willingness-to-pay.
  
  
  CONCLUSIONS
  PC had a high (US$104,500) incremental CE ratio despite lower complication rates, shorter hospital stay and better (nonsignificant) adjusted life expectancy. PC would be cost-effective if it cost US$6400 or SC had an 8% loss of utility or its indirect costs were US$2250. Costs of PC should be reduced to be cost-effective in the Brazilian public health system. Indirect costs and impact on quality of life should be further assessed.
authors.affiliation: Hospital do Coração da Associação do Sanatório Sírio, Sao Paulo, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Costa
authors.forename: Carlos A C
authors.initials: CA
authors.lastname: Pedra
authors.forename: Marcelo
authors.initials: M
authors.lastname: Ribeiro
authors.forename: Simone
authors.initials: S
authors.lastname: Pedra
authors.forename: André Luis
authors.initials: AL
authors.lastname: Ferreira-Da-Silva
authors.forename: Carisi
authors.initials: C
authors.lastname: Polanczyk
authors.forename: Otávio
authors.initials: O
authors.lastname: Berwanger
authors.forename: Alexandre
authors.initials: A
authors.lastname: Biasi
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ribeiro
mesh_terms: D001938:Brazil; D002648:Child; D003362:Cost-Benefit Analysis; D006344:Heart Septal Defects, Atrial / Q000188:drug therapy* / Q000191:economics / Q000601:surgery*; D006801:Humans; D011634:Public Health; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
keywords: atrial septal defect; cost–effectiveness; public health; surgery; transcatheter