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Economic implications of outpatient cardiac catheterisation in infants with single ventricle congenital heart disease

Published online by Cambridge University Press:  26 June 2019

Jamie N. Colombo ,
Michael R. Hainstock ,
Michael C. Spaeder  and
Jeffery E. Vergales
Jamie N. Colombo*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of VirginiaChildren’s Hospital, 1215 Lee Street, Charlottesville, VA 22903, USA
Michael R. Hainstock
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of VirginiaChildren’s Hospital, 1215 Lee Street, Charlottesville, VA 22903, USA
Michael C. Spaeder
Affiliation:
Department of Pediatrics, Division of Pediatric Critical Care, University of VirginiaChildren’s Hospital, 1215 Lee Street, Charlottesville, VA 22903, USA
Jeffery E. Vergales
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of VirginiaChildren’s Hospital, 1215 Lee Street, Charlottesville, VA 22903, USA
*
Author for correspondence: Jamie N. Colombo, DO, Banner University Medical Center, 1501 N. Campbell Ave., Tucson, AZ 85724, USA. Tel: 520-626-5585; Fax: 520-694-9963; E-mail: jamiecolombo@peds.arizona.edu
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Abstract

Background:

Resource utilisation for infants with single ventricle CHD remains high without well-studied ways to decrease economic burden. Same-day discharge following cardiac catheterisation has been shown to be safe and effective in children with CHD, but those with single ventricle physiology are commonly excluded. The purpose of this study was to investigate the economic implications of planned same-day discharge following cardiac catheterisation versus universal overnight hospital admission in infants with single ventricle CHD.

Methods and Results:

A probabilistic decision-tree analysis with sensitivity analyses was performed. All included patients were categorised into four possible outcomes; discharge, readmission following discharge (within 48 hours), observation and prolonged hospitalisation. Baseline probabilities of each node of the tree were then combined with the cost data to evaluate the comparative dominance of one decision (immediately discharge) versus the other decision (routinely admit). Patients discharged on the same day as the procedure accrued the lowest attributed hospital cost ($5469), while patients readmitted to the hospital had the highest attributed cost ($11,851). Currently, no other studies have assessed the cost of hospitalisation following cardiac catheterisation in this population. Thus, we allowed for a wide range of cost variation, but same-day discharge dominated the decision outcome with a lower economic burden.

Conclusion:

Same-day discharge following routine cardiac catheterisation in patients with single ventricle physiology is less costly compared to universal overnight admission. This demonstrates an important cost-limiting step in a complex population of patients who have high resource utilisation.

Keywords

Single ventricle CHDcardiac catheterisationcost analysis
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 7 , July 2019 , pp. 960 - 966
Copyright
© Cambridge University Press 2019 

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