Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children

Abstract

With advances in interventional catheterisation, transcatheter device closure of atrial septal defect (ASD) is now a feasible option to open heart surgery, especially in patients with isolated ASD. We aim to compare the outcomes, benefits and costs between device closure versus standard open-heart surgery for ASD in Singapore. This is a comparative study between 2 cohorts with isolated secundum ASDs who underwent closure of ASD either by surgery or device, at the Department of Paediatrics, National University Hospital (NUH). The clinical outcomes, complications, length of stay and total costs incurred were compared. Surgical patients were at slightly greater risk of developing complications (RR=1.33; 95% CI, 0.30 to 5.95) than the device group. The median length of inpatient stay for the surgical group was significantly longer than that for the device group. Seventy percent of the patients in the device group did not need to be in ICU while 40% of patients in the surgery group stayed 2 or at least 3 days in ICU (P <0.001). The mean cost per successful procedure was $1511 (95% CI, -352 to 3375) higher for the device group patients despite a shorter length of stay in hospital. We concluded that transcatheter device closure is an effective and safe alternative to surgery in the treatment of suitable ASDs. Despite the high cost of the device, direct and indirect benefits for the patients and their families, who undergo device occlusion include less morbidity, better cosmesis, shorter length of stay in hospital, faster recovery and shorter time taken to resume normal activities.