Fontan palliation versus heart transplantation

A comparison of charges

Robert J. Gajarski, Jeffrey Towbin, Arthur Garson

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Surgical approaches to single-ventricle physiologic abnormalities have included Fontan palliation or transplantation. No cost expenditures have been published. This study compared expenditures between the Fontan procedure and heart transplantation. Between 1988 and 1992, records of 82 patients who underwent the Fontan procedure and 26 who underwent transplant were retrospectively reviewed. Charges for Fontan or transplant procedures were accrued from the date of surgical admission until discharge or patient death and included hospital, physician, and diagnostic laboratory charges. Additionally, the frequency and cost of postoperative hospital readmissions, outpatient evaluations, and diagnostic procedures were recorded for each patient. Estimated expenditures for each evaluated parameter were based on 1992 to 1993 dollar charges. The total expenditure (surgery plus yearly follow-up) for transplantation exceeded that for the Fontan procedure ($96,475 vs $29,730; p < 0.001). Although both groups had similar follow-up periods and mortality rates, the number of hospital readmissions and postoperative diagnostic tests was higher among transplant recipients. Within 1 postoperative year at least four high-risk patients who had undergone a Fontan procedure required listing for transplantation; the total costs of their combined procedures (approximately $80,000 + $3,000 to $5,000 annual outpatient charges) was markedly greater than the cost of the Fontan procedure alone. Although the expenditure for heart transplantation far exceeds that for the Fontan procedure, Fontan palliation in high-risk patients is ultimately more costly and increases postoperative morbidity. In this subgroup, we recommend heart transplantation as the initial definitive procedure because it may increase long-term survival rates and minimize health care expenditures.

Original languageEnglish (US)
Pages (from-to)1169-1174
Number of pages6
JournalAmerican Heart Journal
Volume131
Issue number6
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

Fingerprint

Fontan Procedure
Heart Transplantation
Health Expenditures
Costs and Cost Analysis
Patient Readmission
Transplantation
Outpatients
Transplants
Patient Discharge
Routine Diagnostic Tests
Survival Rate
Morbidity
Delivery of Health Care
Physicians
Mortality

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Fontan palliation versus heart transplantation : A comparison of charges. / Gajarski, Robert J.; Towbin, Jeffrey; Garson, Arthur.

In: American Heart Journal, Vol. 131, No. 6, 01.01.1996, p. 1169-1174.

Research output: Contribution to journalArticle

Gajarski, Robert J. ; Towbin, Jeffrey ; Garson, Arthur. / Fontan palliation versus heart transplantation : A comparison of charges. In: American Heart Journal. 1996 ; Vol. 131, No. 6. pp. 1169-1174.
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