Can Variation in Costs for Cardiovascular Procedures Be Attributed to Inefficiency in Care Delivery? Challenges in Causality, Data Availability, and the Need for Price Transparency
Year: 2025
Type: editorial
Abstract: The United States spends twice as much per person on health care compared to other wealthy countries but often experiences worse outcomes.1 High health expenditures have thus become a focus of reform efforts aimed at containing long-term health spending growth.Cost variation across hospitals and regions has been of interest as it may be driven by inefficiencies in care delivery that could be standardized to improve value.However, studying the causal effect of these inefficiencies on cost variation is challenging due to difficulties in estimating cost from administrative data, inherent limitations of datasets, and complex confounding arising from a multitude of variables that influence costs.Understanding cost variation is particularly relevant to the field of cardiology, where innovation brings forth high-cost, life-saving therapies but a potential for misuse or overuse, which may lead to unnecessary spending.2 Left atrial appendage occlusion (LAAO) devices are a case example of a high-cost, lifesaving device for patients with increased risk of thrombosis and stroke due to atrial fibrillation, yet who are intolerant of long-term anticoagulation due to bleeding risk.Disparities in the rollout of new treatments also have implications for costs, especially for long-term prevention of more serious outcomes like stroke.In this issue of Structural Heart, Patil et al. investigated the proportion of variation in total costs for LAAO implantation attributable to centerspecific factors such as procedural volume.3 Their study leverages data from the National Inpatient Sample (NIS), developed by the Healthcare Cost and Utilization Project (HCUP), which represents a random survey sample of 20% of inpatient discharges from most U.S. hospitals.They found that the national median unadjusted patient-level hospitalization cost for LAAO was $24,500, with significant variability (interdecile range, $13,900-37,000).High-volume hospitals had lower costs ($24,000 [interquartile range, $18,700-29,200]) compared to low-volume hospitals ($25,900 [interquartile range, $20,100-33,400]).Their mixed effects model showed that 12.9% of cost variation was due to center-level differences, with high-volume hospitals having lower center-related cost
Source: Structural Heart
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $2,340
OpenAlex ID: W4407271606