Title: Cost of Heart Failure Admissions in Children in the United States
Abstract: Background: The cost of treatment for acute heart failure for adult patients now exceeds 30 billion dollars annually. There are no data on the cost of heart failure admissions in children. Therefore, the purpose of our study was to determine the cost of heart failure admissions in children throughout the United States. Methods: A retrospective analysis of the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database, a nationwide database of pediatric hospital discharges that is weighted to provide national estimates, was performed to determine the cost of heart failure hospitalizations. Factors associated with increased cost were also assessed. Results: There were 15,826 (95% CI 13,363 to 18,229) heart failure admissions, of which cost data were available for 96%. The mean age at admission was 5.24 years (95% CI 4.85 to 5.62). Congenital heart disease was present in 62%, cardiomyopathy in 16%, and myocarditis in 3%. The total cost of heart failure admissions for the year was $753,149,082 (95% CI $601,772,505 to $904,525,659) and the mean hospital cost per patient was $49,354 (95% CI $45,960 to $52,748). The greatest cost was found among patients on extracorporeal membrane oxygenation (mean $196,835 per patient), ventricular assist devices (mean $179,052 per patient), and patients undergoing heart transplantation (mean $197,404 per patient). Patients that died incurred significantly greater costs than patients that survived (mean $97,839 vs $46,149, p < 0.001). On multivariable analysis, patients in the top quartile of cost were more likely to have acute renal failure (OR 4.0, 95% CI 3.1 to 5.0), sepsis (OR 4.4, 95% CI 3.5 to 5.5), undergo a heart transplantation (OR 403.2, 95% CI 99.9 to 1628.1), be placed on extracorporeal membrane oxygenation (OR 26.1, 95% CI 14.4 to 47.1) or a ventricular assist device (OR 19.4, 95% CI 8.4 to 45.0). Conclusion: Pediatric heart failure hospitalizations cost over 750 million dollars annually. Patients undergoing ECMO, ventricular assist devices, or heart transplantation incurred the greatest cost. These data should provide a framework for further study of cost-effective therapies.