title: Cost comparison of Transcatheter and Operative Pulmonary Valve Replacement (from the Pediatric Health Information Systems Database).
abstract: Outcomes for transcatheter pulmonary valve replacement (TC-PVR) and operative pulmonary valve replacement (S-PVR) are excellent. Thus, their respective cost is a relevant clinical outcome. We performed a retrospective cohort study of children and adults who underwent PVR at age ≥ 8 years from January 1, 2011, to December 31, 2013, at 35 centers contributing data to the Pediatric Health Information Systems database to address this question. A propensity score-adjusted multivariable analysis was performed to adjust for known confounders. Secondary analyses of department-level charges, risk of re-admission, and associated costs were performed. A total of 2,108 PVR procedures were performed in 2,096 subjects (14% transcatheter and 86% operative). The observed cost of S-PVR and TC-PVR was not significantly different (2013US $50,030 vs 2013US $51,297; p = 0.85). In multivariate analysis, total costs of S-PVR and TC-PVR were not significantly different (p = 0.52). Length of stay was shorter after TC-PVR (p <0.0001). Clinical and supply charges were greater for TC-PVR (p <0.0001), whereas laboratory, pharmacy, and other charges (all p <0.0001) were greater for S-PVR. Risks of both 7- and 30-day readmission were not significantly different. In conclusion, short-term costs of TC-PVR and S-PVR are not significantly different after adjustment.
authors.affiliation: Division of Cardiology, Children's National Medical Center, Washington, D.C.; Department of Pediatrics, The George Washington School of Medicine, Washington, D.C.. Electronic address: mlobyrne@childrensnational.org.
authors.forename: Michael L
authors.initials: ML
authors.lastname: O'Byrne
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gillespie
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, 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, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, 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, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, 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, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, 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 / Q000379:methods*; D002648:Child; D005260:Female; D017048:Health Care Costs; D063005:Health Information Systems; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000191:economics / Q000379:methods*; D006801:Humans; D008297:Male; D057216:Propensity Score; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult