Ehlers, Lars Holger

Hermansen, Nanna Kastrup

Korsholm, Kasper Krohn

Nielsen-Kudsk, Jens Erik

English

Background: Echocardiographic imaging is paramount during left atrial appendage occlusion (LAAO). Observational studies have demonstrated similar efficacy and safety of intracardiac echocardiography (ICE) from the left atrium and transesophageal echocardiography (TEE).Purpose: To perform a cost-comparison of TEE and ICE guided LAAO by estimating the mean cost per patient

    Aalborg UniversitetCOST-COMPARISON OF INTRACARDIAC AND TRANSESOPHAGEALECHOCARDIOGRAPHY TO GUIDE LEFT ATRIAL APPENDAGE OCCLUSIONHermansen, Nanna Kastrup; Korsholm, Kasper Krohn; Ehlers, Lars Holger; Nielsen-Kudsk,Jens ErikPublication date:2017Link to publication from Aalborg UniversityCitation for published version (APA):Hermansen, N. K., Korsholm, K. K., Ehlers, L. H., & Nielsen-Kudsk, J. E. (2017). COST-COMPARISON OFINTRACARDIAC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY TO GUIDE LEFT ATRIAL APPENDAGEOCCLUSION. Poster presented at TCT 2017, Denver, United States.General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            ? Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            ? You may not further distribute the material or use it for any profit-making activity or commercial gain            ? You may freely distribute the URL identifying the publication in the public portal ?Take down policyIf you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access tothe work immediately and investigate your claim.Downloaded from vbn.aau.dk on: December 26, 2020COST-COMPARISON OF INTRACARDIAC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY TO GUIDE LEFT ATRIAL APPENDAGE OCCLUSIONNanna K. Hermansen1, Kasper Korsholm2, Lars H. Ehlers1, Jens Erik Nielsen-Kudsk21 Danish Center for Healthcare Improvements, Aalborg University   2 Department of Cardiology, Aarhus University Hospital Echocardiographic imaging is paramount during left atrial appendage occlusion (LAAO). Observational studies have demonstrated similar efficacy and safety of intracardiac echocardiography (ICE) from the left atrium and transesophageal echocardiography (TEE)1,2. However, the high cost of ICE catheters may be a concern.Study design•  A retrospective cost-analysis based on a single-center cohort of patients undergoing LAAO at Aarhus University Hospital, Denmark.•  Procedural data, efficacy and safety has been published previously1The Danish Healthcare system•  Publicly financed through general taxes, with equal availability of healthcare to all residents regardless of financial status.•  Individual hospital costs are supported by a system of central government block grants and reimbursement.Cost-identification•  A public hospital perspective with a micro-costing approach was applied to estimate patient-specific in-hospital costs between TEE and ICE guided procedures. •  Costs common to both procedures were excluded from analysisLAAO setupAll patients were admitted the day before the intervention, and had pre-procedural cardiac CT for exclusion of LAA thrombus and device sizing. The LAAO was performed using the Amplatzer Cardiac Plug or Amulet. Patients were admitted overnight for observation and a transthoracic echocardiogram was performed before discharge.To perform a cost-comparison of TEE and ICE guided LAAO by estimating the mean cost per patient.REFERENCES1 Korsholm K, Jensen JM, Nielsen-Kudsk JE. Intracardiac Echocardiography From the Left Atrium for Procedural Guidance of Transcatheter Left Atrial Appendage Occlusion. JACC Cardiovasc Interv. 20172 Frangieh AH, Alibegovic J, Templin C et al. Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with Watchman. Catheter Cardiovasc Interv. 2017 Aug 1;90(2):331-3383 Healthcare Denmark, D & Ministry of Health, D. Healthcare in Denmark. An Overview (2016)Correspondance:Kasper Korsholm, MD, PhD-fellowEmail: Kasperkorsholm@gmail.com•  This is a single-center study based on a public healthcare system. Its generalizability may depend on the reimbursement system and healthcare structure. •  The results are estimates with uncertainty. They reflect only the cost variables included in the analysis.PURPOSEMETHODSThe cost of ICE catheters appears to be balanced out by•  No need for general anesthesia, •  Less personnel required per procedure,•  Reduced overall time used in the catheter lab.Thus, ICE from the left atrium appears to be cost-neutral. This may aid decision-making between TEE and ICE from the left atrium, from a health-economic perspective.CONCLUSIONLIMITATIONSConflicts of interest: JENK: proctor for AbbottKK: speaker’s honorarium from Abbott TEE cohort ICE cohortMean cost pr. patient 4921 (CI: 4350-5697) 5220 (CI: 4951-5610)Admission day cost 17 ± 0 -Pre-procedural turnover cost 1566 ± 568 939 ± 435Procedural cost 2341 ± 1300 4146 ± 432Post-procedural turnover cost 938 ± 470 536 ± 218Post-procedure cost 26 ± 3 -RESULTSMean cost per patient in US dollars. Results are reported with bias-corrected and accelerated 95% confidence intervals or ± standard deviation.Pre-procedural turnover = Time from arrival at the catheter lab to venous puncture. Procedure time = Time from venous puncture till vascular closure.Post-procedural turnover = Time from vascular closure till exit of catheter lab. BACKGROUNDThe in-hospital period was subdivided into 5 time periods, the unique resource use and costs were identified for each period.The results are presented below as mean cost per patient in US Dollars. * Missing by random

COST-COMPARISON OF INTRACARDIAC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY TO GUIDE LEFT ATRIAL APPENDAGE OCCLUSION

https://vbn.aau.dk/ws/files/267571623/Poster_costanalysis.pdf

COST-COMPARISON OF INTRACARDIAC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY TO GUIDE LEFT ATRIAL APPENDAGE OCCLUSION

Abstract

Similar works

Full text

Available Versions

VBN