Abstract
Introduction: Despite a growing emergency department (ED) burden in the aging adult congenital heart disease (ACHD) population, data regarding the cost of ED visits remains unknown. This information could help inform appropriate resource allocation to reduce costs and improve outcomes for ACHD patients. Methods: We used a national commercial insurance database (IBM MarketScan) to characterize total and out-of-pocket (OOP) ED costs for ACHD patients with one or more ED visits in the year 2016. Multivariate linear regression analysis after adjusting for age <40 years, gender, primary beneficiary status, employment, ACHD severity, cardiovascular (CV) and non-CV comorbidities was performed to determine variables associated with ED costs. Results: Of 3,579 ACHD patients with at least one ED visit, 53.4% were female, mean age was 35.5±14.4 years, and 33.2% had severe ACHD. Total (median; 25th, 75th) and OOP costs per visit were $2,004.79; $992.71, $4,034.63 and $232.32; $70, $695.30, respectively. Conditions with the highest per-visit total and OOP costs were neoplasm (total $6,186.89; $4,334, $13,005.19, OOP $329.20; $120, $1799.70), endocrine (total $3,467.51; $1,620.73, $9,878.38, OOP $428.99; $154.50, $1350.25), genitourinary (total $3,433.59; $1,739.97, $7,361.57, OOP $330.16; $120, $868.04), unclassified (total $3,370.04; $1,610, $7,793.22, OOP $347.50; $114.83, $1226.74), and symptoms, signs, and ill-defined (total $3,171.34; $1,740.55, $6,404.77, OOP $340.29; $100, $862.33). Factors independently associated with ED costs included comorbidities, primary beneficiary status, and employment (Figure). Conclusions: Non-CV comorbidities and noncardiac conditions during ED visits contribute substantially to ED costs among ACHD patients. Future studies to identify a collaborative, multidisciplinary care model to manage these noncardiac problems among ACHD patients might help reduce the overall burden of ACHD-related ED costs.
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