Rising charges and costs for pediatric catheter ablation

Abstract

Introduction: Catheter ablation has been shown to be effective for pediatric tachyarrhythmias, but the associated charges and costs have not been described in the recent era. Understanding such contemporary trends may identify ways to keep an effective therapy affordable while optimizing clinical outcomes.

Methods: We used the 1997-2009 Kids' Inpatient Databases to examine trends in charges and costs for pediatric catheter ablation and identify determinants of temporal changes.

Results: There were 7,130 discharges for catheter ablation in the sample. Mean age at ablation was 12.1 ± 0.2 years. Patients with congenital heart disease (CHD) made up 10% of the sample. Complications occurred in 8% of discharges. Mean total charges rose 219% above inflation (from $23,798 ± 1,072 in 1997 to $75,831 ± 2,065 in 2009). From 2003 to 2009, costs rose 25% (from $20,459 ± 780 in 2003 to $25,628 ± 992 in 2009). Charges for ablation increased markedly relative to surgical procedures, but with a similar slope to other catheter-based interventions. Multivariable analysis revealed that year (P < 0.0001), payer (P = 0.0002), CHD (P < 0.0001), valvular heart disease (P = 0.0004), cardiomyopathy (P = 0.0009), hospital region (P < 0.0001), length of stay (P < 0.0001), and complications (P < 0.0001) predicted increased charges. The same factors also predicted increased costs. Charges and costs varied considerably by region, particularly for high-volume centers (P < 0.0001).

Conclusions: Charges and costs for pediatric catheter ablation increased relative to other procedures and significantly outstripped inflation. Further study of complications, length of stay, and regional differences may help control rising costs while maintaining quality of care.

Figure 1

Percent change in charges for significant predictors in the multivariable model. Horizontal bars demonstrate the percent change in charges attributable to each variable over a reference discharge for catheter ablation. Reference discharge features are 2009, age ≥4 years, private payer, SVT diagnosis, lack of structural cardiac disease, length of stay 0 days, no complications, not a high volume center, and Northeast Region.

Figure 2

Change in inflation-adjusted total charges for various pediatric procedures over time. Percent change in charges over time for various pediatric surgical and catheter-based procedures are shown. Charges are adjusted to 2009 dollars, so the percent change illustrated represents changes above the indexed inflation rate for medical care services.