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Title
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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
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Author
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Institution/Organisation
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BELCODAC Consortium
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Abstract
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| 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. |
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Language
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English
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Source (journal)
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The European journal of health economics. - Berlin, 2000, currens
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Publication
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Berlin
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2021
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ISSN
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1618-7598
[print]
1618-7601
[online]
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DOI
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10.1007/S10198-021-01300-5
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Volume/pages
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22
:6
(2021)
, p. 951-960
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ISI
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000638575400002
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Pubmed ID
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33835328
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Full text (Publisher's DOI)
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Full text (open access)
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Full text (publisher's version - intranet only)
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