Cost-Analysis of Percutaneous Pulmonary Valve Implantation Compared to the Standard Surgical Approach

Background: Recently approved in the United States, percutaneous pulmonary valve implantation (PPVI) is an alternative to surgical conduit revision in select patients with congenital right ventricular outflow tract obstruction and pulmonary insufficiency. The objective of this study was to evaluate and model the future costs of the percutaneous option compared to standard surgical approach.

Methods: We examined the last 17 patients who underwent PPVI and compared them with the 17 most-recent surgically placed valves. Economic data comparing the two options was obtained from the actual procedural and in-hospital charges. Societal costs, due to lost wages, were gathered from the U.S. Department of Labor to determine the broader socio-economic impact of each procedure. Sensitivity analysis evaluated the effects of varying reintervention rates to determine a 10-year cost-analysis model for each option.

Results: Groups were similar with respect to age, number of pre-procedure catheterizations and symptoms. Median total hospital and procedural charges incurred by the patient were significantly higher for the surgical valve compared to PPVI ($126,406 ± $38,772 vs. $80,328 ± $17,387, p < 0.001). Median total societal charges were also higher for the surgical valve ($129,519 ± $39,021 vs. $80,939 ± $17,334, p <0.001) owing to an average wage loss of $3,113 for patients who had surgery, contrasted to $611 who underwent PPVI. There was, further, a shorter length of stay (1.0 ± 0 vs. 5.7 ± 2.2, p <0.001) for PPVI. Previously published data suggests a surgical valve reintervention rate of 2% per year. Sensitivity analysis determined that PPVI would need to have a 17% per year failure rate (or 93% at 10-years) to lose its cost-advantage.

Conclusions: Based on recent data, PPVI holds a significant cost advantage over the traditional surgical approach, fewer hospital days, and incurs noticeably less patient wage loss. Further, it would need to have a very high failure rate at 10 years to become less cost-advantageous.