THE COST OF TREATING HEART-VALVE RELATED COMPLICATIONS

Background and aims of the study: Heart valve replacement can result i n serious complications. Therefore, It is important, in decision makin g regarding the choice of valves to know the cost of such complication s. Methods: Complications were defined according to guidelines propose d by the Society of Thoracic Surgeons. They included valve thrombosis, embolism, hemorrhage due to anticoagulation, non-structural dysfuncti on, structural deterioration and endocarditis. The costs of the pre-ad mission assessment, acute inpatient stay, inpatient physician fees, po st-discharge and out-patient physician fees were estimated for each co mplication to determine the average total cost in 1995 US dollars. Cos t inputs were obtained from existing Massachusetts databases and Medic are fee schedules. Results: The costs of managing valve thrombosis, en docarditis and non-structural dysfunction were all estimated to exceed $30,000 for a single event, The costs of acute management of embolism and anticoagulant-related hemorrhage were between $8,000 and $11,500. However, it is of note that managing the sequelae of an embolism was calculated to be greater than $70,000 over 25 years. The greatest cont ributor to the average cost of treating a complication was determined to be the in-patient facility cost. Conclusions: Complications related to heart valve replacement can be very costly to manage in both the s hort term and the long term.