Date of Award

January 2015

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jeremy Asnes

Subject Area(s)

Medicine

Abstract

Right ventricular outflow tract (RVOT) and pulmonary valve dysfunction account for roughly 20% of all congenital heart diseases. Over time, these types of dysfunction can lead to right heart failure, which is associated with significant morbidity and mortality. Improvements in RVOT and pulmonary valve function may reverse some of the deleterious effects. Historically, surgical pulmonary valve replacement has been the mainstay method of pulmonary valve repair. In 2010, percutaneous pulmonary valve implantation (PPVI) was introduced in the US. This study analyzed the healthcare costs for 47 and 51 patients that underwent PPVI and surgical pulmonary repair, respectively, at Yale-New Haven Hospital from 2007 to 2014. The analysis included all costs incurred during the hospital admission and follow-up visits within one month of discharge.

The overall total PPVI and surgery costs were $71,966 ± 16,326 and $90,917 ± 22,639, respectively (p < 0.001). The difference of $18,951 is largely accounted for by the difference in indirect costs, $24,553 ± 7,018 and $36,195 ± 15,735 (p < 0.001). The remaining difference can be attributed to the direct costs, which were broken down by department. Surgery was more costly in nearly all categories, including physician fees, ICU care, and non-ICU care. The only exception was that the PPVI valve ($26,154) cost 3.5 times as much as the surgical valve ($7,556).

A multivariate regression analyses of the overall total cost with patient demographic and clinical characteristics yielded a model consisting of the variable, hospital length of stay, as the only statistically significant predictor of cost (p = 0.016, R-squared = 0.363).

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