Primary superior to staged repair in management of symptomatic tetralogy of Fallot

The primary repair (PR) approach to managing neonates with symptomatic tetralogy of Fallot (sTOF) results in lower costs than that for staged repair (SR), a study has shown.

“Recent data have demonstrated that overall mortality and adverse events are not significantly different for PR and SR approaches to management of neonates with sTOF,” the authors said.

In this study, economic costs associated with PR and SR were compared. The authors combined data from a multicentre retrospective cohort study of neonates with sTOF with administrative data to compare total costs and cost per day alive over the first 18 months of life in a propensity score-adjusted analysis. They also performed a secondary analysis to assess differences in department-level costs.

A total of 324 neonates from six centres from January 2011 to November 2017 were analysed. Of these, 40 percent underwent PR. No significant differences were noted in the 18-month cumulative mortality (p=0.18), procedural complications (p=0.10), hospital complications (p=0.94), and reinterventions (p=0.22) between PR and SR.

However, total 18-month costs were lesser for PR than for SR (median $179,494 vs $222,799; p<0.001). Cost per day alive (p=0.005) and department-level costs were likewise lower for PR. Propensity score-adjusted analyses confirmed the associations of PR with lower total cost (cost ratio, 0.73; p<0.001) and with lower department-level costs.

“Given similar overall mortality between treatment strategies, this finding suggests that PR provides superior value,” the authors said.