1002-89 Cost Effectiveness of Coil Embolization of Patent Ductus Arteriosus

Abstract

Transcatheter closure of patent ductus arteriosus (PDA) using the Rashkind occluder is less effective and more costly than surgical closure. Coil embolization is an alternative method of closing a small PDA. We reviewed our experience to compare current costs of coil embolization and surgical closure. Between 3/3/86 and 8/31/94, 19 patients (ages 16 months to 43 years) underwent cardiac catheterization for possible coil embolization of PDA. Fourteen (74%) had successful coil placement (range of minimum PDA diameter 1.0–3.0 mm; fluoroscopy time 27 ± 10 min). Closure was documented by Doppler echocardiography in 13 patients; one patient with a trace shunt has not had post-catheterization follow-up. Five PDA's were not embolized and had subsequent surgical ligation. Two were not attempted because of deficient aortic diverticulum and 3 failed (2 with minimum PDA diameter > 3.3 mm had snare retrieval of coils embolized into the pulmonary artery and-l was removed due to poor coil position). One of the patients who failed PDA embolization required surgical femoral artery embolectomy. The last nine patients catheterized (12/1/93–8/31/94) were all successfully embolized without complication. Total cost, including all hospital and professional fees, was available in 12 of 14 patients from the embolization group (8 of the last 9). Average cost for all embolizations was $8062 ± 2934. Cost decreased to $6796 ± 941 in the last 8 patients (p < 0.01). Average cost of uncomplicated surgical PDA ligation in 5 patients (ages 16 months to 9 years; 7/1/93 to 8/31/94) was significantly greater at $11,679 ± 1813 (p < 0.05 for all embolizations and p < 0.001 for recent embolizations). Average total cost for unsuccessful embolization followed by surgical closure was $25,582 ± 5120 for the 3 patients who failed embolization. We conclude that coil embolization of small PDA is very effective and is less expensive than surgical closure. Our success rate improved and cost and complication rate decreased with experience.