PCV31: CLOSURE OF ATRIAL SEPTAL DEFECT: MEDICO-ECONOMIC ARGUMENTS TO CHOOSE BETWEEN INVASIVE SURGERY AND PERCUTANEOUS TECHNIQUE USING SEPTAL OCCLUDER

OBJECTIVES: The medical device implantation techniques via percutaneous aboard tend to substitute to surgical techniques, in various cardio-vascular therapeutics. However, prosthesis implantation is often accompanied high implementation costs (linked to the device acquisition) which are difficult to justify to the decision-maker, in a context of high financial constraint. METHOD: Available clinical data show similarity of effectiveness and complication rates between these two techniques. Therefore, the economic appraisal consists in a cost minimization approach. First, we modeled the two technique protocols before costing each action (personnel, facilities, … ) according to the internal costs of Grenoble hospital. Moreover, we estimated the budgetary productivity of these two strategies using the French DRG classification system used to adjust the annual financial allocation of French public hospitals. RESULTS: Results show the percutaneous technique (septal occluder Amplatzer®) is dominant (1.5 times less expensive than surgery), mainly by decreasing the hospital stay (two hospitalization days instead of 12 days in the surgery strategy). DRG system classification generates 1473 ISA (hospital productivity index) for the percutaneous technique and 7556 ISA for invasive surgery. CONCLUSIONS: Comparing between cost-minimization technic using internal costs and incremental budgetary impact using French DRG classification, we conclude that the prosthesis implantation via percutaneous aboard is economically dominant (cheaper than invasive surgery) but 5 times less contributive to annual budget allocation. Therefore incitation for the hospital decision-maker to use septal occluders must come with the adaptation to new technologies of financial public allocation using the DRG classification.