Cost‐analysis of percutaneous pulmonary valve implantation compared to surgical pulmonary valve replacement

OBJECTIVES: To perform cost evaluation and economic modeling of percutaneous pulmonary valve implantation (PPVI) compared to surgical revision. BACKGROUND: While, PPVI appears to be a viable alternative to surgical conduit revision in select patients with right ventricular outflow tract anomalies, its overall economic burden has yet to be determined. METHODS AND RESULTS: We examined the first 17 patients who underwent PPVI at our institution and compared them with the most-recently placed surgical valves. Economic data were obtained from the actual procedural and in-hospital charges and used as the base estimates for 5- and 10-year future modeling with appropriate sensitivity analysis. Median total hospital and procedural charges incurred by the patient were significantly higher for the surgical valve compared with PPVI ($126,406 ± $38,772 vs. $80,328 ± $17,387, P < 0.001). Median total societal charges were also higher for the surgical valve ($129,519 ± $39,021 vs. $80,939 ± $17,334, P < 0.001) owing to an average wage loss of $3,113 for surgical patients, contrasted to $611 who underwent PPVI, and a shorter length of stay (1.0 ± 0 vs. 5.7 ± 2.2, P <0.001) for PPVI. Sensitivity analysis determined that PPVI would need to fail at a rate of 17% per year (or 93% at 10 years) to lose its cost advantage. CONCLUSIONS: PPVI holds a significant cost advantage over the surgical approach, fewer hospital days, and incurs less patient wage loss. Furthermore, it would need to have a very high failure rate at 10 years to lose its cost advantage.