An assessment of the cost of percutaneous pulmonary valve implantation (PPVI) versus surgical pulmonary valve replacement (PVR) in patients with right ventricular outflow tract dysfunction

Figures & data

Figure 1.  Model assumptions for each cycle in the absence of PPVI.

Table 1.  Probabilities of death in each cycle following PVR (based on expert opinion) and of 2nd PVR in cycle (based on Homann et al.,3 and expert opinion).

Cycle	Probability of death in cycle	Probability of PVR in cycle
1	0.05	0.05
2	0.03	0.03
3	0.03	0.03
4	0.02	0.03
5	0.02	0.03
6	0.02	0.03
7	0.02	0.03
8	0.02	0.03
9	0.02	0.03
10	0.01	0.04
11	0.01	0.04
12	0.01	0.04
13	0.01	0.04
14	0.01	0.05
15	0.01	0.05
16	0.01	0.05
17–25	0.01	0.06

Table 2.  Unit costs for PPVI and PVR (Source: Great Ormond Street Hospital).

Item	PPVI (percutaneous pulmonary valve implantation)		PVR (surgical pulmonary valve replacement)
	Mean units	Cost per unit (£)	Mean units	Cost per unit (£)
Procedure/operative time (per hour)	2	574.30	4	542.41
Intensive care bed (per day)	0	1,393.55	2	1,393.55
Hospital bed (per day)	2	426.75	7	426.75
Melody	1	15,900.00	0	15,900.00
Homograft valve	0	1,830.00	1	1,830.00
Delivery system	1	4,100.00	0	4,100.00
Full blood count	1	2.95	2	2.95
Urea and electrolytes	1	0.91	2	0.91
Clotting	1	6.00	1	6.00
Cross match	2	18.36	2	18.36
ECG	3	37.56	3	37.56
Chest X-ray	2	43.14	2	43.14
Echocardiogram*	2	127.42	2	127.42
MRI*	1	686.25	1	686.25
Anaesthesia (per hour)	2	18.09	4	18.09
Inotropes (per hour)	0	5.63	12	5.63
Aspirin (per dose)	90	0.32	0	0.32
IV fluids (per unit)	0	4.53	12	4.53
Blood transfusion (per unit)	0	120.85	2	120.85
Furosemide (per dose)	0	0.77	42	0.77
Other equipment†	1	239.85	1	245.38

*Only clinically indicated investigations.

†Including cardiopulmonary bypass circuit, operative set for the PVR group and contrast and other appropriate catheters for the PPVI group.

Table 3.  Complication costs within the first year (Source: Great Ormond Street Hospital).

	No of cases	Cost per case (£)
PPVI (n = 84)
Surgical revision, emergency	2	13,000.00
Prolonged hospital stay	1	1,399.17
Non-surgical control of bleeding	2	932.78
Cost of within-year complications following PPVI per patient		348.40
PVR (n = 94)
Return to theatre	2	1,185.60
Major neurological event	1	55,186.56
Minor neurological event	1	466.39
Systemic inflammatory response syndrome	1	4,445.17
Tracheostomy	2	24,557.8
Pacemaker	1	4,131.95
Acute renal failure	1	12,278.9
Pleural effusion	2	932.78
Pericardial effusion	4	466.39
Pericarditis	2	466.39
Chest infection	4	932.78
Pneumothorax	1	466.39
Acute psychosis	1	3,264.73
Groin complication	1	932.78
Cost of within-year complications following PVR per patient		1,500.6

Figure 2.  Model assumptions for each cycle in the presence of PPVI.

Table 4.  Probabilities of receiving PVR after PPVI, 2nd PPVI and probability of death in cycle (Data obtained from Great Ormond Street Hospital).

Cycle	Probability of PVR after PPVI in cycle	Probability of death after PPVI in cycle	Probability of 2nd PPVI in cycle
1	0.00	0.00	0.037
2	0.03	0.01	0.061
3–25	0.01	0.01	0.042

Homann M, Haehnel JC, Mendler N, et al. Reconstruction of the RVOT with valved biological conduits: 25 years’ experience with allografts and xenografts. Eur J Cardiothorac Surg 2000;17:624-630

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