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Intracardiac echocardiography (ICE) from the left atrium is effective and safe, and enables left atrial appendage occlusion (LAAO) to be performed in local anesthesia. Thereby, personnel requirements and time spent in the catheter lab is reduced. However, high cost of the ICE catheter might be a concern. Therefore, we performed a cost-comparison analysis of ICE versus TEE guided LAAO.
A single-center, retrospective cost-analysis of LAAO guided by TEE (n=78) or ICE from the left atrium (n=100). All patients had pre-procedural cardiac CT, and underwent LAAO with the ACP or Amulet device. A micro-costing approach was applied to identify patient-specific in-hospital costs. Costs common to both TEE and ICE guided procedures were excluded from the analysis (i.e. LAAO device, cardiac CT, fluoroscopy and discharge echocardiogram). Unique costs for each group were compiled to estimate the mean cost per patient. Reusable equipment (i.e. TEE probes) were priced by actual cost price divided by expected times of reuse with the added cost of re-sterilization. Physician and nurses’ charges were based on salary per minute times actual time used at the catheterization lab or post-anesthesia care unit. Results are presented as mean cost per patient in US dollars, with a bias-corrected and accelerated confidence interval (CI).
Pre-procedural cost per patient was 1601±575 USD for the TEE group, and 949±440 USD for the ICE group. Procedural cost per patient was 2366±1314 USD for TEE guided procedures; and 3741±437 USD for ICE guided. Post-procedural cost per patient was 1622±476 USD for the TEE group, and 1201±221 USD for the ICE group. The overall in-hospital mean cost per patient was 5607 USD (CI: 5022; 6379) in the TEE group, and 5936 USD (CI: 5660; 6323) in the ICE group. The mean difference between TEE and ICE was 329 USD (CI: -56; 638).
The increased cost of the ICE probe appears to be balanced out by less personnel cost, and reduced overall time consumption in the catheter lab. Thus, ICE appears to be a cost-neutral alternative to TEE for guiding LAAO.
STRUCTURAL: Left Atrial Appendage Exclusion