Advertisement

Hospital Inpatient Costs for Single Ventricle Patients Surviving the Fontan Procedure

      We estimated the inpatient resource use for a Fontan patient from birth to adulthood and explored factors that might induce cost differences (2014 US dollar). Inpatient costing records from 4 hospitals with greatest numbers of Fontan patients in Australia and New Zealand were linked with the Fontan registry database. Inpatient records between July 1995 and September 2014 for 420 Fontan patients were linked, and the most frequent primary diagnoses were hypoplastic left heart syndrome (20.7%), tricuspid atresia (19.7%), and double inlet left ventricle (17.1%). The mean hospital cost for a Fontan patient from birth to 18 years of age was estimated to be $390,601 (95% confidence interval [CI] $264,703 to $516,499), corresponding to 164 (95% CI 98 to 231) inpatient days. The cost incurred from birth through to Fontan completion (the staged procedures period) was $219,482 (95% CI $202,410 to $236,553) and the cost thereafter over 15 years was $146,820 (95% CI $44,409 to $249,231), corresponding to 82 (95% CI 72 to 92) and 65 (95% CI 18 to 112) inpatient days, respectively. Costs were higher in male and hypoplastic left heart syndrome patients in the staged procedures period (p <0.001). Having fenestration was associated with higher costs in the staged procedures period (p <0.001) and lower cost after Fontan over 15 years (p = 0.66). In conclusion, patients with single ventricle congenital heart disease continue to demand considerable inpatient resources after the staged procedures period. Over 40% of the pediatric hospital costs for Fontan patients were estimated to occur after the last planned surgery.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • O'Leary P.W.
        Prevalence, clinical presentation and natural history of patients with single ventricle.
        Prog Pediatr Cardiol. 2002; 16: 31-38
        • Iyengar A.J.
        • Winlaw D.S.
        • Galati J.C.
        • Gentles T.L.
        • Weintraub R.G.
        • Justo R.N.
        • Wheaton G.R.
        • Bullock A.
        • Celermajer D.S.
        • d'Udekem Y.
        The Australia and New Zealand Fontan registry: description and initial results from the first population-based Fontan registry.
        Intern Med. 2014; 44: 148-155
        • Graham T.P.
        The year in congenital heart disease.
        J Am Coll Cardiol. 2008; 52: 1492-1499
        • Gordon B.M.
        • Rodriguez S.
        • Lee M.
        • Chang R.K.
        Decreasing number of deaths of infants with hypoplastic left heart syndrome.
        J Pediatr. 2008; 153: 354-358
        • Schilling C.
        • Dalziel K.M.
        • Nunn R.
        • Plessis K.D.
        • Shi W.Y.
        • Celermajer D.
        • Winlaw D.
        • Weintraub R.G.
        • Grigg L.E.
        • Radford D.J.
        • Bullock A.
        • Gentles T.L.
        • Wheaton G.R.
        • Hornung T.S.
        • Justo R.N.
        • d'Udekem Y.
        The Fontan epidemic: population projections from the Australia and New Zealand Fontan registry.
        Int J Cardiol. 2016; 219: 14-19
        • Chang R.K.
        • Chen A.Y.
        • Klitzner T.S.
        Clinical management of infants with hypoplastic left heart syndrome in the United States, 1988–1997.
        Pediatrics. 2002; 110: 292-298
        • Prsa M.
        • Holly C.D.
        • Carnevale F.A.
        • Justino H.
        • Rohlicek C.V.
        Attitudes and practices of cardiologists and surgeons who manage HLHS.
        Pediatrics. 2010; 125: e625-e630
        • Wernovsky G.
        The paradigm shift toward surgical intervention for neonates with hypoplastic left heart syndrome.
        Arch Pediatr Adolesc Med. 2008; 162: 849-854
        • Keren R.
        • Luan X.
        • Localio R.
        • Hall M.
        • McLeod L.
        • Dai D.
        • Srivastava R.
        Prioritization of comparative effectiveness research topics in hospital pediatrics.
        Arch Pediatr Adolesc Med. 2012; 166: 1155-1164
        • Gajarski R.J.
        • Towbin J.A.
        • Garson A.
        Fontan palliation versus heart transplantation: a comparison of charges.
        Am Heart J. 1996; 131: 1169-1174
        • Dean P.N.
        • Hillman D.G.
        • McHugh K.E.
        • Gutgesell H.P.
        Inpatient costs and charges for surgical treatment of hypoplastic left heart syndrome.
        Pediatrics. 2011; 128: e1181-e1186
        • Thomas I.D.
        • Seckeler M.D.
        Resource utilization for noncardiac admissions in pediatric patients with single ventricle disease.
        Am J Cardiol. 2016; 117: 1661-1666
        • Collins R.T.
        • Doshi P.
        • Onukwube J.
        • Fram R.Y.
        • Robbins J.M.
        Risk factors for increased hospital resource utilization and in-hospital mortality in adults with single ventricle congenital heart disease.
        Am J Cardiol. 2016; 118: 453-462
        • d’Udekem Y.
        • Iyengar A.J.
        • Cochrane A.D.
        • Grigg L.E.
        • Ramsay J.M.
        • Wheaton G.R.
        • Penny D.J.
        • Brizard C.P.
        The Fontan procedure: contemporary techniques have improved long-term outcomes.
        Circulation. 2007; 116: I-157-I-164
        • Lassman D.
        • Hartman M.
        • Washington B.
        • Andrews K.
        • Catlin A.
        US health spending trends by age and gender: selected years 2002-10.
        Health Aff. 2014; 33: 815-822
        • Carins T.A.
        • Shi W.Y.
        • Iyengar A.J.
        • Nisbet A.
        • Forsdick V.
        • Zannino D.
        • Gentles T.
        • Radford D.J.
        • Justo R.
        • Celermajer D.S.
        • Bullock A.
        • Winlaw D.
        • Wheaton G.
        • Grigg L.
        • d'Udekem Y.
        Long-term outcomes after first-onset arrhythmia in Fontan physiology.
        J Thorac Cardiovasc Surg. 2016; 152: 1355-1363
        • Cantekin K.
        • Cantekin I.
        • Torun Y.
        Comprehensive dental evaluation of children with congenital or acquired heart disease.
        Cardiol Young. 2013; 23: 705-710
        • Stecksén-Blicks C.
        • Rydberg A.
        • Nyman L.
        • Asplund S.
        • Svanberg C.
        Dental caries experience in children with congenital heart disease: a case-control study.
        Int J Paediatr Dent. 2004; 14: 94-100
        • Jeffries H.E.
        • Wells W.J.
        • Starnes V.A.
        • Wetzel R.C.
        • Moromisato D.Y.
        Gastrointestinal morbidity after Norwood palliation for hypoplastic left heart syndrome.
        Ann Thorac Surg. 2006; 81: 982-987
        • Thorne S.A.
        • Hooper J.
        • Kemp M.
        • Somerville J.
        Gastro-intestinal protein loss in late survivors of Fontan surgery and other congenital heart disease.
        Eur Heart J. 1998; 19: 514-520