Abstract 18744: Rising Costs of Adult Congenital Heart Disease Care: Does Gender Matter?

Abstract

Introduction: The profile of congenital heart disease (CHD) has shifted, now with more adults than children who have survived. Few studies have provided a global assessment of adult congenital heart disease (ACHD) healthcare cost in the United States. Methods: Data from the National Inpatient Sample (2002-2012) utilizing diagnostic ICD-9 codes for moderate and complex ACHD were analyzed. Hospital discharges, total billed and reimbursed amounts, gender and age disparities were evaluated. Results: There was an overall increase in ACHD discharges (Moderate CHD: 4,742 vs. 6,545, Severe CHD: 807 vs. 1,115), billed and reimbursed dollar amounts (Billed: $542,703,961 vs. $1,506,945,042, +178%; reimbursed: $221,417,779 vs. $432,797,543, +95%). Women had more discharges in 2002 but not in 2012 (men: women, 2002: 6,503 vs. 7,805; 2012: 7,715 vs. 7,200) [Figure 1A]. Gender-based billed amounts followed a similar trend (2002: $262,918,357 vs. $279,785,604; 2012: $844,923,857 vs. $$662,021,185; p=0.006) as did total reimbursed (2002: $107,766,175 vs. $113,651,604; 2012: $243,183,638 vs. $189,613,905, p=0.008) [Figure 1B,C]. Healthcare expenditure increased across all age groups: this was most prominent in the > 44 vs. 18-44 yr. group (Billed: $617,589,813 vs. $346,652,267, p<0.001; reimbursed: $136,013,528 vs. $75,366,237, p<0.001). Conclusions: We are the first to report a change in the rate of gender-based ACHD hospitalizations, whereby men now account for more hospitalizations in the U.S. As ACHD discharges, billed and reimbursed amounts continue to rise over the last decade, we are also the first to demonstrate increased expenditure in older (> 44 yrs.) ACHD patients, a pattern that we predict will continue to grow and requires future investigation.