Key result
Primary repair was associated with lower total healthcare costs over the first 18 months of life compared to staged repair in neonates with symptomatic tetralogy of Fallot.
Why the study?
Recent data showed no significant difference in mortality or adverse events between primary and staged repair approaches for neonates with symptomatic tetralogy of Fallot, but economic cost comparisons were lacking.
Does primary repair reduce 18-month total hospital costs compared to staged repair in neonates with symptomatic tetralogy of Fallot?
Cohort (n=324)
Yes
Does primary repair reduce 18-month total hospital costs compared to staged repair in neonates with symptomatic tetralogy of Fallot?
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“What is fascinating is that this first study, [published March 2021 in the Journal of the American College of Cardiology], did not show a big difference in outcomes in these two types of strategies. Whether you palliate the newborns and then do a complete repair when they're older or you do the complete repair early on, there doesn't seem to be a big benefit one way or the other. The complete repair comes with slightly more morbidity and mortality upfront, but when you see these patients later in their lives, they tend to do a little bit better than those whose complete repair was awaiting them at 6 to 12 months of age. Looking overall at the outcomes when patients are about five years of age, they're about the same.”
“An important takeaway from our study is that there are trade-offs relative to outcomes between the staged and primary repair approaches to management of symptomatic neonatal TOF. Furthermore, we do not yet know all of the implications of the discrepancies between the two groups or how they manifest later in life, particularly with regard to longer-term effects on patient health and development”
Primary repair for neonatal symptomatic tetralogy of Fallot provides superior economic value, demonstrating lower healthcare costs with comparable 18-month mortality and morbidity versus staged repair.
Background: Recent data have demonstrated that overall mortality and adverse events are not significantly different for primary (PR) and staged repair (SR) approaches to management of neonates with symptomatic tetralogy of Fallot (sTOF). Cost data can be used to compare the relative value (cost for similar outcomes) of these approaches and are a potentially more sensitive measure of morbidity. Objectives: To compare the economic costs associated with PR and SR in neonates with sTOF. Methods: Data from a multicenter retrospective cohort study of neonates with sTOF were merged with administrative data to compare total costs and cost-per-day-alive over the first 18 months-of-life in a propensity-score-adjusted analysis. A secondary analysis evaluated differences in department-level costs. Results: In total, 324 subjects from 6 centers from 1/2011 – 11/2017 were studied (40% PR). 18-month cumulative mortality (p=0.18), procedural complications (p=0.10), hospital complications (p=0.94), and reinterventions (p=0.22) did not differ between PR and SR. Total 18-month costs for PR (median: $179,494, IQR:121,760–310,721) were less than for SR (median: $222,799, IQR:167,581–327,113, p<0.001). Cost-per-day-alive (p=0.005) and department-level costs were also all lower for PR. In propensity score adjusted analyses, PR was associated with lower total cost (cost ratio: 0.73, p<0.001) and lower department-level costs. Conclusion: In this multicenter study of neonates with sTOF, PR was associated with lower costs. Given similar overall mortality between treatment strategies, this finding suggests that PR provides superior value.
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Goldstein et al. (2021) conducted a cohort in Symptomatic tetralogy of Fallot (n=324). Primary repair vs. Staged repair was evaluated on Total hospital cost over the first 18 months of life (Cost ratio 0.73, 95% CI 0.63-0.85, p=<0.001). Primary repair was associated with lower total healthcare costs over the first 18 months of life compared to staged repair in neonates with symptomatic tetralogy of Fallot.
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