Longitudinal Health Care Cost in Hypoplastic Left Heart Syndrome Palliation
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.
KeywordsCost Value Hypoplastic left heart syndrome Congenital heart disease Norwood procedure
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.
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.
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.
- 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
- 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
- 13.James BC, Poulsen GP (2016) The case for capitation. Harvard Bus Rev 94:102–111Google Scholar