Percutaneous Patent Foramen Ovale closure: A Medico-Economic Study

Abstract

We are facing an exponential request for PFO closure since the last recommendations of the French societies of vascular neurology and cardiology. Because of the lack of anesthesiologists resources in public institution to perform transoesophagial echocardiography (TEE)-guided procedures, we are performing PFO closure under intracardiac ultrasound guidance (ICE). Given the cost of this equipment, we conducted a medico-economic study to compare TOE and ICE guided procedure. All the patients who underwent PFO closure between January and June 2018 were included. The overall cost of each procedure were analysed including hospital stay fees, procedure and device cost and anesthesia costs when applicable, and was compared with reimbursement data extracted from medicalized information system program. Fifty-eight patients stays were analyzed. Thirsty-six procedures were performed under local anesthesia with ICE guidance versus 24 under GA with TEE guidance. The overall cost for the FPO closure under GA was 2995.59 € (including an overall anesthesia procedure cost of 908.37 €) versus 4048.42 € for non-sedated procedure with ICE guidance. Associated costs excluding the price of the PFO device itself was 31 € for procedures under GA and 1531 € for non-sedated procedures (including the cost of the ICE catheter). Stays level of severity was level 1 severity in 74%. Average length of stay was to 2.74 days. The average income for the hospital was 2970.91 € for level 1 severity stays and 5164.52 € for level 2 severity stays. For level 1 severity stays, the use of an ICE catheter leads to a deficit of 917.34 €/stay, while a procedure under GA leads to a benefit ok 71.38 €/stay. Decreasing the length of stay without compromising patients’ safety and defining the appropriate cost of ICE catheters with the industry and health authorities would permit to find safe and sustainable strategies for PFO closure.