title: Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects.
abstract: BACKGROUND
  Clinical outcomes for transcatheter and operative closures of atrial septal defects (ASDs) are similar. Economic cost for each method has not been well described.
  
  
  METHODS
  A single-center retrospective cohort study of children and adults<30 years of age undergoing closure for single secundum ASD from January 1, 2007, to April 1, 2012, was performed to measure differences in inflation-adjusted cost of operative and transcatheter closures of ASD. A propensity score weight-adjusted multivariate regression model was used in an intention-to-treat analysis. Costs for reintervention and crossover admissions were included in primary analysis.
  
  
  RESULTS
  A total of 244 subjects were included in the study (64% transcatheter and 36% operative), of which 2% (n = 5) were ≥18 years. Crossover rate from transcatheter to operative group was 3%. Risk of reintervention (P = .66) and 30-day mortality (P = .37) were not significantly different. In a multivariate model, adjusted cost of operative closure was 2012 US $60,992 versus 2012 US $55,841 for transcatheter closure (P < .001). Components of total cost favoring transcatheter closure were length of stay, medications, and follow-up radiologic and laboratory testing, overcoming higher costs of procedure and echocardiography. Professional costs did not differ. The rate of 30-day readmission was greater in the operative cohort, further increasing the cost advantage of transcatheter closure. Sensitivity analyses demonstrated that costs of follow-up visits influenced relative cost but that device closure remained favorable over a broad range of crossover and reintervention rates.
  
  
  CONCLUSIONS
  For single secundum ASD, cost comparison analysis favors transcatheter closure over the short term. The cost of follow-up regimens influences the cost advantage of transcatheter closure.
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA. Electronic address: obyrnem@email.chop.edu.
authors.forename: Michael L
authors.initials: ML
authors.lastname: O'Byrne
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gillespie
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA.
authors.forename: Russell T
authors.initials: RT
authors.lastname: Shinohara
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Dori
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000191:economics*; D006348:Cardiac Surgical Procedures / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D005260:Female; D017048:Health Care Costs; D006344:Heart Septal Defects, Atrial / Q000601:surgery* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D057194:Intention to Treat Analysis; D008297:Male; D010359:Patient Readmission / Q000191:economics; D057216:Propensity Score; D012044:Regression Analysis; D012189:Retrospective Studies; D055815:Young Adult