Longitudinal Health Care Cost in Hypoplastic Left Heart Syndrome Palliation

  • Jesse E. Hansen
  • Nicolas L. Madsen
  • Laurie Bishop
  • David L. S. Morales
  • Jeffrey B. Anderson
Original Article

Abstract

Management of hypoplastic left heart syndrome (HLHS) is resource intensive. Heath care systems are pressured to provide value to patients by improving outcomes while decreasing costs. A single-center retrospective cohort of infants with HLHS who underwent Norwood procedure or hybrid Norwood from 2004 to 2014 and survived to first outpatient follow up were studied. The primary outcome was total cost through 12 months with a sub-analysis of patients with 60 months of data. Costs were calculated using internal cost accounting system and reported by cost center. Of the 152 HLHS patients identified, 69 met inclusion criteria. Stage I hospitalization (n = 69), with a median length of stay 34 days [interquartile range (IQR) 24–58 days], resulted in a median cost of $203,817 (IQR $136,236–272,453). Of survivors at 12 months (n = 55), the median cost was $369,393 (IQR $216,289–594,038) generated in part by a median of 67 (40–126 days) hospitalized days during that year. A subgroup analysis of patients who reached 60 months of age (n = 29) demonstrated a median total cost of $391,812 (IQR $293,801–577,443) and a median of 74 lifetime hospitalized days (IQR 58–116 days). High cost centers included intensive care (41%), non-ICU hospital (17%), operative services (11%), catheterization lab (9%), and pharmacy (9%). Using multiple regression analysis, significant drivers of cost included reoperation, length of hospitalization, low birthweight, and use of ECMO. Costs related to HLHS management are driven both by care-related complications such as surgical re-intervention and patient factors such as low birth weight.

Keywords

Cost Value Hypoplastic left heart syndrome Congenital heart disease Norwood procedure 

Notes

Acknowledgements

The authors would like to acknowledge the support of the Heart Institute Research Core at Cincinnati Children’s Hospital Medical Center in the development and completion of this project. We also appreciate Dr. Andrew F. Beck’s time and expertise in collecting and analyzing the geographic and socioeconomic measures included in our data set.

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The authors assert that all procedures contributing to this work comply with the ethical standards of United States Code of Federal Regulations 45 CFR 46 on the protection of human subjects and with the Helsinki Declaration of 1975, as revised in 2008, and has been approved by the institutional review board at Cincinnati Children’s Hospital Medical Center.

References

  1. 1.
    Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A (2008) Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr 153:807–813CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, Subcommittee AHASCaSS (2017) Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation 135:e146–e603CrossRefGoogle Scholar
  3. 3.
    Faraoni D, Nasr VG, DiNardo JA (2016) Overall hospital cost estimates in children with congenital heart disease: analysis of the 2012 kid’s inpatient database. Pediatr Cardiol 37:37–43CrossRefPubMedGoogle Scholar
  4. 4.
    Pasquali SK, Sun JL, d’Almada P, Jaquiss RD, Lodge AJ, Miller N, Kemper AR, Lannon CM, Li JS (2011) Center variation in hospital costs for patients undergoing congenital heart surgery. Circ Cardiovasc Qual Outcomes 4:306–312CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Pasquali SK, Jacobs ML, He X, Shah SS, Peterson ED, Hall M, Gaynor JW, Hill KD, Mayer JE, Jacobs JP, Li JS (2014) Variation in congenital heart surgery costs across hospitals. Pediatrics 133:e553–e560CrossRefGoogle Scholar
  6. 6.
    Pasquali SK, Jacobs JP, Bove EL, Gaynor JW, He X, Gaies MG, Hirsch-Romano JC, Mayer JE, Peterson ED, Pinto NM, Shah SS, Hall M, Jacobs ML (2015) Quality-cost relationship in congenital heart surgery. Ann Thorac Surg 100:1416–1421CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Smith AH, Gay JC, Patel NR (2014) Trends in resource utilization associated with the inpatient treatment of neonatal congenital heart disease. Congenit Heart Dis 9:96–105CrossRefPubMedGoogle Scholar
  8. 8.
    Porter ME (2010) What is value in health care? N Engl J Med 363:2477–2481CrossRefPubMedGoogle Scholar
  9. 9.
    Morris SA, Ethen MK, Penny DJ, Canfield MA, Minard CG, Fixler DE, Nembhard WN (2014) Prenatal diagnosis, birth location, surgical center, and neonatal mortality in infants with hypoplastic left heart syndrome. Circulation 129:285–292CrossRefPubMedGoogle Scholar
  10. 10.
    Kucik JE, Nembhard WN, Donohue P, Devine O, Wang Y, Minkovitz CS, Burke T (2014) Community socioeconomic disadvantage and the survival of infants with congenital heart defects. Am J Public Health 346:e150–e157Google Scholar
  11. 11.
    Daebritz SH, Nollert GD, Zurakowski D, Khalil PN, Lang P, del Nido PJ, Mayer JE Jr, Jonas RA (2000) Results of Norwood stage I operation: comparison of hypoplastic left heart syndrome with other malformations. J Thorac Cardiovasc Surg 119:358–367CrossRefPubMedGoogle Scholar
  12. 12.
    Porter ME, Pabo EA, Lee TH (2013) Redesigning primary care: a strategic vision to improve value by organizing around patients’ needs. Health Aff (Millwood) 32:516–525CrossRefGoogle Scholar
  13. 13.
    James BC, Poulsen GP (2016) The case for capitation. Harvard Bus Rev 94:102–111Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jesse E. Hansen
    • 1
  • Nicolas L. Madsen
    • 1
  • Laurie Bishop
    • 2
  • David L. S. Morales
    • 1
  • Jeffrey B. Anderson
    • 1
  1. 1.Department of Pediatrics, Heart InstituteCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Division of Biostatistics and Epidemiology, Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations