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Longitudinal Cost of Septal Myectomy Versus Alcohol Septal Ablation for Hypertrophic Cardiomyopathy

      Abstract

      Objective

      To compare the postprocedural health care utilization and cost of septal myectomy (SM) and alcohol septal ablation (ASA).

      Patients and Methods

      Using the OptumLabs Data Warehouse, we analyzed de-identified claims data of adult patients undergoing SM and ASA for obstructive hypertrophic cardiomyopathy from January 1, 2006, through December 31, 2018. We used propensity score weighting to compare the 2-year incidence rates of emergency department visits and rehospitalizations after SM and ASA.

      Results

      We identified 953 patients in total: 660 underwent SM and 293 underwent ASA. There was no difference in the risk (odds ratio, 1.1; 95% CI, 0.6 to 1.8) or frequency (incidence rate ratio, 1.1; 95% CI, 0.8 to 1.5) of emergency department visits, but the annual risk of hospital readmission was 10.8% after SM and 25.9% after ASA during the second postoperative year (P=.004). In those who were ever readmitted, the average length of hospital stay within the first 2 years after ASA was 1.6 times as long as that after SM (incidence rate ratio, 1.6; 95% CI, 1.0 to 2.4). Overall, the 2-year cumulative postprocedural cost was significantly higher after ASA (P<.001).

      Conclusion

      Compared with ASA, SM is associated with fewer hospital readmissions and lower 2-year postprocedural health care cost.

      Abbreviations and Acronyms:

      AF (atrial fibrillation), ASA (alcohol septal ablation), ED (emergency department), HCM (hypertrophic cardiomyopathy), IRR (incidence rate ratio), LVOT (left ventricular outflow tract), OLDW (OptumLabs Data Warehouse), OR (odds ratio), SM (septal myectomy)
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