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Direct medical costs of pediatric congenital heart disease surgery in a Belgian university hospital

Ruben Willems (UGent) , Philip Tack (UGent) , Katrien Francois (UGent) and Lieven Annemans (UGent)
Author
Organization
Abstract
Objectives: The recent trend to optimize the efficiency of health-care systems requires objective clinical and economic data. European data on the cost of surgical procedures to repair or palliate congenital heart disease in pediatric patients are lacking. Methods: A single-center study was conducted. Bootstrap analysis of variance and bootstrap independent t test assessed the excess direct medical costs associated with minor and major complications in nine surgical procedure types, from a health-care payer perspective. Generalized linear models with log-link function and inverse Gaussian family were used to determine associated covariates with the total hospitalization cost. Descriptive statistics show the repartition between out-of-pocket expenditures and reimbursed costs. Results: Four hundred thirty-seven patients were included. Mean hospitalization costs ranged from Euro11,106 (atrial septal defect repair) to Euro33,865 (Norwood operation). Operations with major complications yielded excess costs compared to operations with no complications, ranging from Euro7,105 (+65.2%) for a truncus arteriosus repair to Euro27,438 (+251.7%) for a tetralogy of Fallot repair. Differences in costs were limited between operations with minor versus no complications. Age at procedure, intensive care unit stay, procedure risk category, reintervention, and postoperative mechanical circulatory support were associated with higher total hospitalization costs. Out-of-pocket expenditures represented 6% of total hospitalization costs. Conclusion: Operations with major complications yield excess costs, compared to operations with minor or no complications. Cost data and attribution are important to improve clinical practice in a cost-effective manner. The health-care system benefits from strategies and technological advancements that have an impact on modifiable cost-affecting parameters.
Keywords
pediatric, cost analysis, congenital heart surgery, health economics, RANDOMIZED-TRIALS, HEALTH-CARE, COMPLICATIONS, RESOURCES, OPERATION, OUTCOMES

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MLA
Willems, Ruben, et al. “Direct Medical Costs of Pediatric Congenital Heart Disease Surgery in a Belgian University Hospital.” WORLD JOURNAL FOR PEDIATRIC AND CONGENITAL HEART SURGERY, vol. 10, no. 1, 2019, pp. 28–36, doi:10.1177/2150135118808747.
APA
Willems, R., Tack, P., Francois, K., & Annemans, L. (2019). Direct medical costs of pediatric congenital heart disease surgery in a Belgian university hospital. WORLD JOURNAL FOR PEDIATRIC AND CONGENITAL HEART SURGERY, 10(1), 28–36. https://doi.org/10.1177/2150135118808747
Chicago author-date
Willems, Ruben, Philip Tack, Katrien Francois, and Lieven Annemans. 2019. “Direct Medical Costs of Pediatric Congenital Heart Disease Surgery in a Belgian University Hospital.” WORLD JOURNAL FOR PEDIATRIC AND CONGENITAL HEART SURGERY 10 (1): 28–36. https://doi.org/10.1177/2150135118808747.
Chicago author-date (all authors)
Willems, Ruben, Philip Tack, Katrien Francois, and Lieven Annemans. 2019. “Direct Medical Costs of Pediatric Congenital Heart Disease Surgery in a Belgian University Hospital.” WORLD JOURNAL FOR PEDIATRIC AND CONGENITAL HEART SURGERY 10 (1): 28–36. doi:10.1177/2150135118808747.
Vancouver
1.
Willems R, Tack P, Francois K, Annemans L. Direct medical costs of pediatric congenital heart disease surgery in a Belgian university hospital. WORLD JOURNAL FOR PEDIATRIC AND CONGENITAL HEART SURGERY. 2019;10(1):28–36.
IEEE
[1]
R. Willems, P. Tack, K. Francois, and L. Annemans, “Direct medical costs of pediatric congenital heart disease surgery in a Belgian university hospital,” WORLD JOURNAL FOR PEDIATRIC AND CONGENITAL HEART SURGERY, vol. 10, no. 1, pp. 28–36, 2019.
@article{8587730,
  abstract     = {Objectives: The recent trend to optimize the efficiency of health-care systems requires objective clinical and economic data. European data on the cost of surgical procedures to repair or palliate congenital heart disease in pediatric patients are lacking. 
Methods: A single-center study was conducted. Bootstrap analysis of variance and bootstrap independent t test assessed the excess direct medical costs associated with minor and major complications in nine surgical procedure types, from a health-care payer perspective. Generalized linear models with log-link function and inverse Gaussian family were used to determine associated covariates with the total hospitalization cost. Descriptive statistics show the repartition between out-of-pocket expenditures and reimbursed costs. 
Results: Four hundred thirty-seven patients were included. Mean hospitalization costs ranged from Euro11,106 (atrial septal defect repair) to Euro33,865 (Norwood operation). Operations with major complications yielded excess costs compared to operations with no complications, ranging from Euro7,105 (+65.2%) for a truncus arteriosus repair to Euro27,438 (+251.7%) for a tetralogy of Fallot repair. Differences in costs were limited between operations with minor versus no complications. Age at procedure, intensive care unit stay, procedure risk category, reintervention, and postoperative mechanical circulatory support were associated with higher total hospitalization costs. Out-of-pocket expenditures represented 6% of total hospitalization costs. 
Conclusion: Operations with major complications yield excess costs, compared to operations with minor or no complications. Cost data and attribution are important to improve clinical practice in a cost-effective manner. The health-care system benefits from strategies and technological advancements that have an impact on modifiable cost-affecting parameters.},
  author       = {Willems, Ruben and Tack, Philip and Francois, Katrien and Annemans, Lieven},
  issn         = {2150-1351},
  journal      = {WORLD JOURNAL FOR PEDIATRIC AND CONGENITAL HEART SURGERY},
  keywords     = {pediatric,cost analysis,congenital heart surgery,health economics,RANDOMIZED-TRIALS,HEALTH-CARE,COMPLICATIONS,RESOURCES,OPERATION,OUTCOMES},
  language     = {eng},
  number       = {1},
  pages        = {28--36},
  title        = {Direct medical costs of pediatric congenital heart disease surgery in a Belgian university hospital},
  url          = {http://dx.doi.org/10.1177/2150135118808747},
  volume       = {10},
  year         = {2019},
}

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