Longitudinal Cost of Septal Myectomy Versus Alcohol Septal Ablation for Hypertrophic Cardiomyopathy |
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| Affiliation: | 1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN;2. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;3. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;4. OptumLabs, Cambridge, MA;1. Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK;2. Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK;3. Population Health Research Institute, Hamilton, Ontario, Canada;4. Department of Medicine and Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;5. Division of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA;6. Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA;7. Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA;8. Deborah Heart and Lung Center, Browns Mill, NJ, USA;9. Division of Cardiology, Rush Medical College, Rush University, Chicago, IL, USA;10. Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA;1. Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China;2. Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden;1. Department of Gastroenterology and Hepatology, Fiona Stanley Fremantle Hospital Group, Murdoch, Western Australia, Australia;2. Faculty of Medicine, The University of Queensland, Herston, Brisbane, Queensland, Australia;3. Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia;4. School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia;1. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom;2. Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom;3. Human Performance Lab, Education, Physical Activity and Health Research Unit, University Católica del Maule, Talca, Chile;1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA |
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| Abstract: | ObjectiveTo compare the postprocedural health care utilization and cost of septal myectomy (SM) and alcohol septal ablation (ASA).Patients and MethodsUsing the OptumLabs Data Warehouse, we analyzed de-identified claims data of adult patients undergoing SM and ASA for obstructive hypertrophic cardiomyopathy from January 1, 2006, through December 31, 2018. We used propensity score weighting to compare the 2-year incidence rates of emergency department visits and rehospitalizations after SM and ASA.ResultsWe identified 953 patients in total: 660 underwent SM and 293 underwent ASA. There was no difference in the risk (odds ratio, 1.1; 95% CI, 0.6 to 1.8) or frequency (incidence rate ratio, 1.1; 95% CI, 0.8 to 1.5) of emergency department visits, but the annual risk of hospital readmission was 10.8% after SM and 25.9% after ASA during the second postoperative year (P=.004). In those who were ever readmitted, the average length of hospital stay within the first 2 years after ASA was 1.6 times as long as that after SM (incidence rate ratio, 1.6; 95% CI, 1.0 to 2.4). Overall, the 2-year cumulative postprocedural cost was significantly higher after ASA (P<.001).ConclusionCompared with ASA, SM is associated with fewer hospital readmissions and lower 2-year postprocedural health care cost. |
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