Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits,The European Journal of Health Economics

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Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits
The European Journal of Health Economics ( IF 5.271 ) Pub Date : 2021-04-09 , DOI: 10.1007/s10198-021-01300-5
Ruben Willems ₁ , Fouke Ombelet ₂ , Eva Goossens _{2,

3,

4} , Katya De Groote ₅ , Werner Budts _{6,

7} , Stéphane Moniotte ₈ , Michèle de Hosson ₉ , Liesbet Van Bulck _{2,

4} , Ariane Marelli ₁₀ , Philip Moons _{2,

11,

12} , Julie De Backer _{4,

9} , Lieven Annemans ₁ ,

Affiliation

Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42, Floor 4, 9000, Ghent, Belgium.
KU Leuven Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven-University of Leuven, Leuven, Belgium.
Division of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium.
Research Foundation Flanders (FWO), Brussels, Belgium.
Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.
KU Leuven Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.
Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.
Pediatric and Congenital Cardiology Division, St-Luc University Hospital, Brussels, Belgium.
Department of Adult Congenital Cardiology, Ghent University Hospital, Ghent, Belgium.
McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, QC, Canada.
University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden.
Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.

Aim

To scrutinize the economic impact of different care levels, such as shared care, in the follow-up of adult congenital heart disease (ACHD) patients.

Methods

The BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC) was analyzed. Patients (N = 6579) were categorized into five care levels based on their cardiac follow-up pattern between 2006 and 2010. Medical costs, hospitalizations, and emergency department visits were measured between 2011 and 2015.

Results

In patients with moderate lesions, highly specialized cardiac care (HSC; exclusive follow-up by ACHD specialists) and shared care with predominantly specialized cardiac care (SC+) were associated with significantly lower medical costs and resource use compared to shared care with predominantly general cardiac care (SC−) and general cardiac care (GCC). In the patient population with mild lesions, HSC was associated with better economic outcomes than SC− and GCC, but SC+ was not. HSC was associated with fewer hospitalizations (− 33%) and less pharmaceutical costs (− 46.3%) compared to SC+. Patients with mild and moderate lesions in the no cardiac care (NCC) group had better economic outcomes than those in the GCC and SC− groups, but post-hoc analysis revealed that they had a different patient profile than patients under cardiac care.

Conclusion

More specialized care levels are associated with better economic outcomes in patients with mild or moderate lesions in cardiac follow-up. Shared care with strong involvement of ACHD specialists might be a management option to consider. Characteristics of patients without cardiac follow-up but good medium-term economic prospects should be further scrutinized.

中文翻译：

成人先天性心脏病随访的不同级别护理：审查对医疗费用、住院和急诊就诊的影响的成本分析

目的

审查不同护理水平（例如共享护理）在成人先天性心脏病 (ACHD) 患者的随访中的经济影响。

方法

比利时先天性心脏病数据库结合管理和临床数据 (BELCODAC) 进行了分析。根据 2006 年至 2010 年期间的心脏随访模式，将患者 ( N = 6579) 分为五个护理级别。 2011 年至 2015 年期间测量了医疗费用、住院费用和急诊就诊次数。

结果

在中度病变患者中，与以普通心脏为主的共享护理相比，高度专业化的心脏护理（HSC；由 ACHD 专家进行独家随访）和与以专科心脏护理为主的共享护理 (SC+) 显着降低医疗成本和资源使用护理 (SC-) 和一般心脏护理 (GCC)。在具有轻度病变的患者群体中，HSC 与比 SC- 和 GCC 更好的经济结果相关，但 SC+ 则不然。与 SC+ 相比，HSC 与更少的住院治疗 (- 33%) 和更少的药物成本 (- 46.3%) 相关。与 GCC 和 SC- 组相比，无心脏护理 (NCC) 组轻度和中度病变患者的经济结果更好，但事后分析显示，他们的患者情况与接受心脏护理的患者不同。