Percutaneous Pulmonary Valves Have Higher Costs Than Surgery at 5 Years

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Because they carry a higher reintervention rate, percutaneous pulmonary valves cost approximately $20,000 more than surgical valve replacement over 5-year follow-up. Even so, a shortened hospital stay and recovery time mean that the new therapy “compares reasonably well” to surgery, according to a small study published online May 31, 2011, ahead of print in the American Journal of Cardiology.

Researchers led by William T. Mahle, MD, of Children’s Healthcare of Atlanta (Atlanta, GA), conducted a retrospective analysis of pulmonary valve procedures performed at their center between 2004 and 2010. In all, 6 pediatric patients received a Melody valve (Medtronic, Minneapolis, MN) and 33 underwent surgical conduit revision; the choice of valved conduit varied but calculations were based on the Freestyle bioprosthesis (Medtronic).

The investigators developed a model to compare total hospital costs between the 2 procedures and to estimate midterm cost-savings over 5 years. Reintervention rates were based on published data. All costs were adjusted for inflation and expressed in 2010 US dollars.

After Initial Costs, Reinterventions the Difference

Median hospital stay was lower for the Melody-treated patients than for surgery patients (2 days vs. 4 days; P = 0.001). The latter group had an intensive care unit stay of 29 hours (range, 20-129 hours) and mechanical respiratory support lasting 16 hours (range, 8-63 hours). All percutaneous valve patients, in contrast, were admitted directly to the step-down unit without intensive care unit admission.

Although the cost of the Melody device and the Ensemble delivery catheter (Medtronic) were higher than for their surgical counterparts, hospital costs and physician fees were lower for the percutaneous valve group. Therefore, initial costs were nearly equivalent between the 2 treatments (table 1).

Table 1. Initial Costs

By 5 years, however, the total cost of treatment was nearly $20,000 higher with the percutaneous valve than with surgery because of a greater need for reintervention (table 2).

Table 2. Estimated Reintervention Rates, Cost at 5 Years

Dr. Mahle and colleagues offer several caveats to their analysis. Because the Melody valve is a relatively new technology, with approximately 500 cases worldwide since its introduction in 2000, per-unit costs for the device are likely to drop, they say. In addition, a shorter learning curve and device modifications over time might improve results for percutaneous pulmonary valves, which would influence cost effectiveness.

“The societal cost that is incurred during recovery times [after both percutaneous and surgical procedures] and from right ventricular dysfunction before intervention should also be taken into account,” the study authors write, adding that the shorter hospital stay and ability for both patients and parents to resume normal activities more quickly would favor the interventional approach. “Although the tangible effects of these advantages of [percutaneous pulmonary valves] are difficult to calculate accurately, physicians and their patients likely take these advantages into account when making a decision regarding intervention.”

 

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Source:
Gatlin SW, Kim DW, Mahle WT. Cost analysis of percutaneous pulmonary valve replacement. Am J Cardiol. 2011;Epub ahead of print.

 

 

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