Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits

Ruben Willems (), Fouke Ombelet, Eva Goossens, Katya De Groote, Werner Budts, Stéphane Moniotte, Michèle de Hosson, Liesbet Van Bulck, Ariane Marelli, Philip Moons, Julie De Backer and Lieven Annemans
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Ruben Willems: Ghent University
Fouke Ombelet: KU Leuven-University of Leuven
Eva Goossens: KU Leuven-University of Leuven
Katya De Groote: Ghent University Hospital
Werner Budts: KU Leuven-University of Leuven
Stéphane Moniotte: St-Luc University Hospital
Michèle de Hosson: Ghent University Hospital
Liesbet Van Bulck: KU Leuven-University of Leuven
Ariane Marelli: McGill University Health Center
Philip Moons: KU Leuven-University of Leuven
Julie De Backer: Research Foundation Flanders (FWO)
Lieven Annemans: Ghent University

The European Journal of Health Economics, 2021, vol. 22, issue 6, No 9, 960 pages

Abstract: Abstract Aim To scrutinize the economic impact of different care levels, such as shared care, in the follow-up of adult congenital heart disease (ACHD) patients. Methods The BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC) was analyzed. Patients (N = 6579) were categorized into five care levels based on their cardiac follow-up pattern between 2006 and 2010. Medical costs, hospitalizations, and emergency department visits were measured between 2011 and 2015. Results In patients with moderate lesions, highly specialized cardiac care (HSC; exclusive follow-up by ACHD specialists) and shared care with predominantly specialized cardiac care (SC+) were associated with significantly lower medical costs and resource use compared to shared care with predominantly general cardiac care (SC−) and general cardiac care (GCC). In the patient population with mild lesions, HSC was associated with better economic outcomes than SC− and GCC, but SC+ was not. HSC was associated with fewer hospitalizations (− 33%) and less pharmaceutical costs (− 46.3%) compared to SC+. Patients with mild and moderate lesions in the no cardiac care (NCC) group had better economic outcomes than those in the GCC and SC− groups, but post-hoc analysis revealed that they had a different patient profile than patients under cardiac care. Conclusion More specialized care levels are associated with better economic outcomes in patients with mild or moderate lesions in cardiac follow-up. Shared care with strong involvement of ACHD specialists might be a management option to consider. Characteristics of patients without cardiac follow-up but good medium-term economic prospects should be further scrutinized.

Keywords: Healthcare economics; Congenital heart disease; Health services; Follow-up care (search for similar items in EconPapers)
JEL-codes: D61 I11 (search for similar items in EconPapers)
Date: 2021
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DOI: 10.1007/s10198-021-01300-5

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