Abstract
Background:
Limited data is available on health care cost of balloon aortic valvuloplasty (BAV). We analyzed trends and predictors of cost for BAV over the last decade (2001-2010).
Methods:
The analysis is based on Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) between 2001 and 2010 using the ICD9 procedure code of 35.96 for valvuloplasty. Only patients with age > 60 years with aortic stenosis were included & those with concomitant mitral, tricuspid or pulmonic stenosis were excluded. NIS represents 20% of all hospitals in US. We examined selective contribution of patient demographics, hospital characteristics, Charlson Comorbidity Index (CCI) and peri-procedural complications to hospitalization cost by using mixed effects linear regression modeling. For each year, cost was adjusted for inflation according to 2010 cost. Operator & hospital volume were calculated based on the unique operator and hospital identification numbers. Operator volume data were available for only 50% of the population.
Results:
Total 1,525 (weighted n = 7,595) BAV were performed from 2001 to 2010 with available cost data. Weighted cost of hospitalization for BAV increased from $21,562 in 2001 to $29,559 in 2010 (p for trend < 0.001). In a multivariable model including operator volume, 748 (weighted n = 3,708) BAV were available for analysis. The independent predictors of increased cost of hospitallization were occurrence of periprocedural complications ($22,509; p < 0.001), unstable patient, defined as having ICD-9 code for shock or ventilator dependence ($24,856; p < 0.001) and weekend admission ($11,416; p=0.002). Predictors of decreased cost for BAV were increase in operator volume (-$1,929 per every unit increase, p = 0.006). Increase in hospital valvuloplasty volume (-$1,644 per every 10 units increase, p = 0.2) showed a trend of decreasing cost, but this was statistically non-significant.
Conclusion:
In our current observational study we identified peri-procedural complications, unstable patient & weekend admission to be associated with increased cost & increase in operator volume to be associated with decreased cost of hospitalization for BAV. We also found a significant trend of increase in cost of hospitalization from 2001 to 2010.