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Are We Allocating Resources Responsibly In Children With Hypoplastic Left Heart Syndrome: The Cost Of Mortality.
Amir Mehdizadeh-Shrifi, MD, Muhammad Faateh, MBBS, Hosam Ahmed, MD,PhD, Spencer Hogue, BS, Michael Carlisle, MD, Haleh Heydarian, MD, Marco Ricci, MD, MBA, David Lehenbauer, MD, Awais Ashfaq, David Morales, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Objective(s):The hypoplastic-left-heart-syndrome(HLHS) burden is considerable,yet traditional comparisons have not accounted for the costs related to HLHS-mortality. The authors sought to analyze HLHS-mortality-related resource-utilization.
Methods:HLHS-children were identified from the pediatric-health-information-system(2004-2024) and included if followed-up from birth to the age of 5-years or if died during this time. Inflation-adjusted costs,charges and health-care-resource-utilization were compared between patients who died vs survivors.
Results:A total of 696 5-year survivors and 3,698 with mortality within 5-years were identified. The median age at death was 2[1.2-6.5]months. Deceased patients received significantly higher numbers of imaging-studies(Deceased:100[57-173]-Survivors:75[52-144]),unique-drugs(Deceased:166[88-253]-Survivors:92[70-144],),and non-cardiac procedures(Deceased:24[7-41]-Survivors:16[5-21]). We are spending$585million in-total costs with a per-patient-median of $0.8million[0.5-1.5] on patients alive at 5-years and $2.7billion in-total-costs(4.6-times more) with a per-patient-median of 1.2million[0.5m-1.8m]for children who died at 2-months. In-total we are charging$1.5billion with a per-patient median of $2.1million[1.3-3.9] for patients alive at 5-years and$6.8billion with a per-patient median of $3.1million[1.4-5.2] for children who died at 2-months(4.2-times). The total costs and charges in the last five-years are more than twice what they were in the previous 16-years in-total.
Conclusions:
HLHS-children who do not survive beyond 2-months absorb 4-5-times more financial-resources than 5-year-survivors and this cost is accelerating. The disproportionate resource-utilization on patients dying after stage-1-palliation raises sincere concerns and warrants identifying patients at high-risk of intensive resource-utilization with poor survival,so improvements in survival and resource-allocation at the center-and national-level can be implemented.
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