Lesion-Specific Factors Contributing to Inhospital Costs in Adults With Congenital Heart Disease

      The population of adults with congenital heart disease (ACHD) in the United States is growing rapidly with concomitant increases in care costs. We sought to define the variables having the greatest influence on annual cost of inpatient care in patients with ACHD in the United States. To do so, we conducted a retrospective analysis of admissions in patients >18 years old with a 3-digit International Classification of Disease, Ninth Revision, code of 745 to 747 from the State Inpatient Databases of Arkansas (2008 to 2010), California (2003 to 2012), Florida (2005 to 2012), Hawaii (2006 to 2010), Nebraska (2003 to 2011), and New York (2005 to 2012). We selected variables we believed would have the greatest effect on care costs and built a series of multivariable regression models grouping patients by congenital lesion to examine the relative contribution of the specified variables to total annual inpatient cost. We analyzed a total of 68,314 patients aged 57 ± 18.6 years, 51% of whom were women. The multivariable regression model had an overall R2 of 0.35. Readmission was responsible for 10.3% of annual inpatient cost among all patients with ACHD and had the greatest effect on inpatient care cost for each congenital lesion except Eisenmenger syndrome and conotruncal abnormalities, for both of which it was the second most significant contributor. Other major contributors to annual inpatient care costs included length of stay and operative procedures. In conclusion, rehospitalization is the most significant contributor to annual inpatient cost for individual patients with ACHD in the United States, regardless of underlying anatomy.
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        • Rothberg M.B.
        • Cohen J.
        • Lindenauer P.
        • Maselli J.
        • Auerbach A.
        Little evidence of correlation between growth in health care spending and reduced mortality.
        Health Aff. 2010; 29: 1523-1531
        • Auerbach D.I.
        • Kellermann A.L.
        A decade of health care cost growth has wiped out real income gains for an average US family.
        Health Aff (Millwood). 2011; 30: 1630-1636
        • Mensah G.A.
        • Brown D.W.
        An overview of cardiovascular disease burden in the United States.
        Health Aff (Millwood). 2007; 26: 38-48
        • Marelli A.J.
        • Mackie A.S.
        • Ionescu-Ittu R.
        • Rahme E.
        • Pilote L.
        Congenital heart disease in the general population: changing prevalence and age distribution.
        Circulation. 2007; 115: 163-172
        • Marelli A.J.
        • Ionescu-Ittu R.
        • Mackie A.S.
        • Guo L.
        • Dendukuri N.
        • Kaouache M.
        Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010.
        Circulation. 2014; 130: 749-756
        • O'Leary J.M.
        • Siddiqi O.K.
        • de Ferranti S.
        • Landzberg M.J.
        • Opotowsky A.R.
        The changing demographics of congenital heart disease hospitalizations in the United States, 1998 through 2010.
        JAMA. 2013; 309: 984-986
        • Opotowsky A.R.
        • Siddiqi O.K.
        • Webb G.D.
        Trends in hospitalizations for adults with congenital heart disease in the U.S..
        J Am Coll Cardiol. 2009; 54: 460-467
        • Afilalo J.
        • Therrien J.
        • Pilote L.
        • Ionescu-Ittu R.
        • Martucci G.
        • Marelli A.J.
        Geriatric congenital heart disease: burden of disease and predictors of mortality.
        J Am Coll Cardiol. 2011; 58: 1509-1515
        • Tutarel O.
        • Kempny A.
        • Alonso-Gonzalez R.
        • Jabbour R.
        • Li W.
        • Uebing A.
        • Dimopoulos K.
        • Swan L.
        • Gatzoulis M.A.
        • Diller G.P.
        Congenital heart disease beyond the age of 60: emergence of a new population with high resource utilization, high morbidity, and high mortality.
        Eur Heart J. 2014; 35: 725-732
        • Steiner C.
        • Elixhauser A.
        • Schnaier J.
        The healthcare cost and utilization project: an overview.
        Eff Clin Pract. 2002; 5: 143-151
        • Broberg C.
        • McLarry J.
        • Mitchell J.
        • Winter C.
        • Doberne J.
        • Woods P.
        • Burchill L.
        • Weiss J.
        Accuracy of administrative data for detection and categorization of adult congenital heart disease patients from an electronic medical record.
        Pediatr Cardiol. 2015; 36: 719-725
        • Jencks S.F.
        • Williams M.V.
        • Coleman E.A.
        Rehospitalizations among patients in the Medicare fee-for-service program.
        N Engl J Med. 2009; 360: 1418-1428
        • Curtis J.P.
        • Schreiner G.
        • Wang Y.
        • Chen J.
        • Spertus J.A.
        • Rumsfeld J.S.
        • Brindis R.G.
        • Krumholz H.M.
        All-cause readmission and repeat revascularization after percutaneous coronary intervention in a cohort of Medicare patients.
        J Am Coll Cardiol. 2009; 54: 903-907
        • Meadows E.S.
        • Bae J.P.
        • Zagar A.
        • Sugihara T.
        • Ramaswamy K.
        • McCracken R.
        • Heiselman D.
        Rehospitalization following percutaneous coronary intervention for commercially insured patients with acute coronary syndrome: a retrospective analysis.
        BMC Res Notes. 2012; 5: 342
        • Fonarow G.C.
        • Stevenson L.W.
        • Walden J.A.
        • Livingston N.A.
        • Steimle A.E.
        • Hamilton M.A.
        • Moriguchi J.
        • Tillisch J.H.
        • Woo M.A.
        Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure.
        J Am Coll Cardiol. 1997; 30: 725-732
        • Amin A.N.
        • Jhaveri M.
        • Lin J.
        Temporal pattern and costs of rehospitalization in atrial fibrillation/atrial flutter patients with one or more additional risk factors.
        J Med Econ. 2012; 15: 548-555
        • Billett J.
        • Majeed A.
        • Gatzoulis M.
        • Cowie M.
        Trends in hospital admissions, in-hospital case fatality and population mortality from congenital heart disease in England, 1994 to 2004.
        Heart. 2008; 94: 342-348
        • Khairy P.
        • Ionescu-Ittu R.
        • Mackie A.S.
        • Abrahamowicz M.
        • Pilote L.
        • Marelli A.J.
        Changing mortality in congenital heart disease.
        J Am Coll Cardiol. 2010; 56: 1149-1157

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