THE COST OF CONGENITAL HEART-DISEASE IN CHILDREN AND ADULTS - A MODEL FOR MULTICENTER ASSESSMENT OF PRICE AND PRACTICE VARIATION

Objective: To assess the cost of congenital heart disease (CHD) and to assess whether practice pattern or price was more responsible for variation. Research Design and Setting: Data were collected from Charleston, NC; Columbus, Ohio; Detroit, Mich; Houston, Tex; Los Angeles, Calif; and New York, NY. The CHD was first classified as to physiologic characteristics and severity. For each type of CHD, the number of clinic visits, hospitalizations, and years of medication use were estimated. Results: On the basis of actual charges, the ''prices'' were calculated as follows, in 1992 dollars: for patients from birth to 21 years: benign disease (19% of patients), $3940; acyanotic disease (45%), $49 730; cyanotic disease (36%), $102 084; and average for all CHD categories, $59 877; for patients 22 to 40 years of age (of whom 24% had resolved defects or were dead): benign disease (19%), $3470; acyanotic disease (52%), $12 981; cyanotic disease (29%), $39 187; and average for all CHD, S18 773. The cost for the group from birth to 21 years varied from $47 500 to $73 600, accounting for 55% by practice (number of echocardiograms and cardiac catheterizations) and 45% by price, although mortality was similar. Conclusions: The treatment of CHD is comparatively inexpensive, especially in adult survivors. The variation in both practice and price bears further study, with comparisons to determine the most cost-effective strategies for treating these patients.