Cost Analysis of Minimally Invasive Mitral Valve Surgery in the UK National Health Service.

BACKGROUND In the United Kingdom National Health Service, finite resources make the adoption of minimally invasive mitral valve surgery challenging unless greater operative costs (vs sternotomy) are balanced by post-operative savings. We examined whether the cost analysis now became unfavourable. METHODS All patients (n=380) undergoing isolated mitral valve surgery ± maze over a 3-year period via either minimally invasive (MI) or sternotomy approaches (ST) were included. Propensity matching (two 1:1 matched cohorts, n=75 per group) and multivariable regression were used to assess for the effect on cost. Cost data were prospectively collected from Service Line Reporting and reported in Sterling (£) as median (IQR). RESULTS Matched data revealed total hospital costs were equivalent (MI vs ST, £16672 (15044, 20611) vs £15875 (12281, 20687), p=0.33). Three of 15 costing pools were significantly different: operative costs were higher for the MI group (MI vs ST, £7458 (6738, 8286) vs £5596 (4204, 6992), p<0.001) while ward costs (boarding, nursing) (MI vs ST, £1464 (1146, 1864) vs £1733 (1403, 2445), p=0.006), and pharmacy services (MI vs ST, £187 (140, 239) vs £244 (179, 375), p<0.001) were lower for the MI group. Hospital stay was shorter in the MI group (MI vs ST, 6 days (5, 8) vs 8 days (6, 11), p<0.001). Multivariable regression produced similar findings. CONCLUSIONS There was no difference in overall hospital cost between MI and ST mitral valve surgery: higher operative costs of MI surgery were offset by lower post-operative costs, with a 2-day shorter hospital stay.