title: Cost-effectiveness of procedures for treatment of ostium secundum atrial septal defects occlusion comparing conventional surgery and septal percutaneous implant.
abstract: OBJECTIVE
  The study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant.
  
  
  METHODS
  A model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant.
  
  
  RESULTS
  The results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio.
  
  
  CONCLUSIONS
  The proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation.
authors.affiliation: Centre of Technology Assessment in Health, National Institute of Cardiology, Rio de Janeiro, Brazil.
authors.forename: Márcia Gisele Santos
authors.initials: MG
authors.lastname: da Costa
authors.affiliation: Centre of Technology Assessment in Health, National Institute of Cardiology, Rio de Janeiro, Brazil.
authors.forename: Marisa da Silva
authors.initials: Mda S
authors.lastname: Santos
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: Flávia Mori
authors.initials: FM
authors.lastname: Sarti
authors.affiliation: Centre of Technology Assessment in Health, National Institute of Cardiology, Rio de Janeiro, Brazil.
authors.forename: Kátia Marie
authors.initials: KM
authors.lastname: Simões e Senna
authors.affiliation: Centre of Technology Assessment in Health, National Institute of Cardiology, Rio de Janeiro, Brazil.
authors.forename: Bernardo Rangel
authors.initials: BR
authors.lastname: Tura
authors.affiliation: Centre of Technology Assessment in Health, National Institute of Cardiology, Rio de Janeiro, Brazil.
authors.forename: Marcelo Goulart
authors.initials: MG
authors.lastname: Correia
authors.affiliation: Centre of Technology Assessment in Health, National Institute of Cardiology, Rio de Janeiro, Brazil.
authors.forename: Marcelo Correia
authors.initials: MC
authors.lastname: Goulart
mesh_terms: D054087:Atrial Septum / Q000601:surgery*; D001938:Brazil; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006344:Heart Septal Defects, Atrial / Q000191:economics* / Q000601:surgery* / Q000628:therapy; D006801:Humans; D019736:Prostheses and Implants / Q000191:economics*