OBJECTIVE: To find out the cost analysis and outcome comparison of Amplatzer® Ductal Occluder-II (ADO-II), Nit Occlud® Lê Coil, and Multifunctional Occluder (MFO) devices for ventricular septal defect transcatheter closure.
METHOD: This was a cross-sectional study conducted from May 2015-April 2019 at Sanglah Hospital Indonesia (regional 2, medical service level 3). Subjects were collected using consecutive sampling method, divided into three groups: ADO-II, Nit Occlud® Lê Coil, and MFO. The primary outcomes were comparison of total cost and hospital earnings from Indonesia Case Based Groups (INA-CBG’s) coverage. Other variables were procedure time, fluoroscopy time, and complication. Statistical analysis was done using Kruskal-Wallis test for the primary outcome, and two-way ANOVA and ANCOVA for the subgroups analysis.
RESULT: Total subjects were 88, divided into groups: ADO-II (n=34), Nit Occlud® Lê Coil (n=33), and MFO (n=21). The median age was 30 months (2-624 months), 9.1% of those were more than 18 year-old. The procedure success rate was high in all groups. Real cost was higher in Nit Occlud® Lê Coil group compared to other two groups (p<0.001). Comparison of hospital earnings showed significant difference between ADO-II, Nit Occlud® Lê Coil, and MFO (median -1,633,850 vs -14,006,600 vs -1,247,900 respectively; p=0.016); adjustment for length of hospital stay found similar results (p=0.005). Subgroup analysis by admission class found no significant difference of hospital earnings among all groups. Procedure and fluoroscopy time were shorter in ADO-II compared to other groups (p=0.001 and 0.003). Analysis of complication found no significant difference among all groups.
CONCLUSION: Percutaneous VSD closure using either ADO-II, Nit Occlud® Lê Coil, and MFO is feasible and safe in selected patients. Amplatzer® Ductal Occluder-II can be choose considering the low cost and short procedure time.