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Value-Based Comparison of Transcatheter vs. Surgical Closure of Atrial Septal Defects
Study Questions:
Does transcatheter or surgical closure of atrial septal defect (ASD) confer greater value, with value defined as outcomes relative to costs?
Methods:
A retrospective cohort study was conducted using data from the Pediatric Hospital Information System (PHIS). Total charges for procedure-related encounters were converted to costs using hospital-specific cost-to-charge ratios, and all costs were adjusted for inflation to reflect 2012 dollars.
Results:
A total of 4,606 transcatheter procedures and 3,159 surgeries were performed in children ages 1-17 years at 35 children’s hospitals. Those undergoing transcatheter closure were older (5.6 years vs. 4.5 years, p < 0.0001). There was no mortality in either group. Length of stay was longer in the surgical group (4.0 days vs. 1.5 days, p < 0.0001), and were more likely to have an infection (odds ratio, 3.73; p < 0.0001) or procedural complication (odds ratio, 6.66; p < 0.001). Costs for transcatheter procedure encounters were lower than costs for surgical encounters (mean $19,128 vs. $25,359, p < 0.0001), with significant variability between hospitals.
Conclusions:
Both transcatheter and surgical ASD closure are associated with excellent short-term outcomes. Transcatheter procedures had lower lengths of stay, rates of infection, and complications, resulting in lower overall costs. Transcatheter ASD closure appears to provide better short–term value than surgical ASD closure.
Perspective:
This large, retrospective study based on PHIS data demonstrated greater value of transcatheter ASD closure over surgical closure. Not surprisingly, there was a wide variation in procedural costs between centers, with device closure actually more expense that surgical closure at some centers. However, on average, costs were lower with transcatheter closure, as one might expect with shorter hospital stay and lack of cardiac bypass. In general, transcatheter closure appears preferable to surgical closure, although it should be noted that not all defects may be amenable to transcatheter intervention.
Keywords: Cardiac Catheterization, Cardiac Surgical Procedures, Heart Septal Defects, Atrial, Heart Defects, Congenital, Hospital Costs, Hospital Information Systems, Length of Stay, Pediatrics
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