Differences in Cost of Care by Palliation Strategy for Infants With Ductal-Dependent Pulmonary Blood Flow

Bryan H. Goldstein, Michael L. O’Byrne, Christopher J. Petit, Athar M. Qureshi, Dingwei Dai, Heather M. Griffis, Ashton France, Michael S. Kelleman, Courtney E. McCracken, Christopher E. Mascio, Subi Shashidharan, R. Allen Ligon, Wendy Whiteside, W. Jack Wallen, Hitesh Agrawal, Varun Aggarwal, Andrew C. Glatz

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


BACKGROUND: In infants with ductal-dependent pulmonary blood flow, initial palliation with patent ductus arteriosus (PDA) stent or modified Blalock-Taussig (BT) shunt have comparable mortality but discrepant length of stay, procedural complication rates and reintervention burdens, which may influence cost. The relative economic impact of these palliation strategies is unknown. METHODS AND RESULTS: Retrospective study of infants with ductal-dependent pulmonary blood flow palliated with PDA stent (n=104) or BT shunt (n=251) from 2008 to 2015 at 4 centers of the Congenital Catheterization Research Collaborative. Inflation-adjusted inpatient hospital costs were calculated for first year of life using Pediatric Health Information System data. Costs derived from outpatient catheterizations not in Pediatric Health Information System were imputed. Costs were compared using propensity score-adjusted multivariable models, to account for baseline differences between groups. After propensity score adjustment, first year of life costs were significantly lower in PDA stent ($215825 [190644–244333]) than BT shunt ($249855 [230693–270609]) patients (P=0.05). After addition of imputed costs, first year of life costs were not significantly different between PDA stent ($226403 [200274–255941]) and BT shunt ($252072 [232955–272759]) groups (P=0.15). Patient characteristics associated with higher costs included: younger gestational age, genetic syndrome, noncardiac diagnoses, procedural complications, extracorporeal membrane oxygenation, duration of ventilation, intensive care unit and hospital length of stay and reintervention (P≤0.02 for all). CONCLUSIONS: In this first multicenter comparative cost study of PDA stent or BT shunt as palliation for infants with ductal-dependent pulmonary blood flow, adjusted for baseline differences, PDA stent was associated with lower to equivalent costs over the first year of life. Combined with previous evidence suggesting clinical noninferiority, these findings suggest that PDA stent provides competitive health care value.

Original languageEnglish (US)
JournalCirculation: Cardiovascular Interventions
Issue number4
StatePublished - Apr 1 2019

Bibliographical note

Funding Information:
Financial support for this research was derived, in part, from the Kennedy Hammill Pediatric Cardiac Research Fund, the Liam Sexton Foundation and A Heart Like Ava.

Publisher Copyright:
© 2019 American Heart Association, Inc.


  • Catheterization
  • Cost analysis
  • Ductus arteriosus
  • Intensive care unit
  • Length of stay
  • Stents

PubMed: MeSH publication types

  • Journal Article


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