Cost-Effectiveness of Procedures for Treatment of Ostium Secundum Atrial Septal Defects Occlusion Comparing Conventional Surgery and Septal Percutaneous Implant

Abstract

ObjectivesThe study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant.MethodsA model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant.ResultsThe results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio.ConclusionsThe proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation.

Budget impact analysis of the percutaneous septal occluder for treatment of ostium secundum atrial septal defects in the Brazilian Unified National Health System

“…The budget impact analysis was conducted as an addition to the economic assessment performed by Costa et al 14 , showing that the percutaneous septal occluder was significantly more effective and less costly when compared to conventional surgery from the perspective of SUS.…”

“…The study estimated the financial impact of the incorporation of the percutaneous septal occluder compared to conventional surgery for ostium secundum ASD, in order to provide additional information to the economic assessment by Costa et al 14 . Data on the efficacy and safety of the two procedures were obtained from a previously published systematic review 14 .…”

“…Data on the efficacy and safety of the two procedures were obtained from a previously published systematic review 14 .…”

“…A recently published economic assessment using Brazilian databases showed that ASD occlusion with percutaneous septal occluder is more cost-effective than conventional surgery 14 . The current study adds information to the results published by Costa et al 14 , aimed at providing evidence on the financial impact of adopting the percutaneous occluder, for decision-makers in the public sector of the Brazilian health care system, in order to support the definitive incorporation of percutaneous atrial septal occluder implant as the procedure of choice and its adoption in public hospitals.…”

Safety and efficacy of transthoracic versus transesophageal echocardiography in transcatheter closure of atrial septal defects

“… 27 , 28 In addition, it was demonstrated that percutaneous procedures are more cost-effective and allow reducing the physical and psychological distress to the patients, as well as the operative time and hospital stay. 29 , 30 On the other hand, surgical techniques still have an advantage over percutaneous transcatheterization, in that they allow closure of larger ASDs regardless of the types and rims. 20 …”