Results and cost analysis of Amplatzer® Ductal Occluder-ii, Nit Occlud® Lê Coil, and Konar-MF® ventricular septal defect occluder for percutaneous ventricular septal defect closure

Abstract

Background: A number of devices have been used for percutaneous closure of ventricular septal defect (VSD) in this era of Jaminan Kesehatan Nasional. The aim of this study is to describe the differences in results and cost analysis of various devices used for percutaneous closure of VSD. Patients and methods: This retrospective study was done in 88 patients underwent transcatheter VSD closure between May 2015-April 2019 at Sanglah Hospital Indonesia (regional 2, medical service level 3). Three types of devices were compared: Amplatzer® Ductal Occluder-II (ADO-II®), Nit Occlud® Lê Coil, and KONAR-MF® VSD Occluder (MFO®). Total cost and hospital earnings from Indonesia Case Based Groups (INA-CBG’s), procedure outcomes, and complications were recorded. Statistical analysis was done using Kruskal-Wallis test and Mann-Whitney test. Results: Successful deployment of ADO-II® Nit Occlud, ® Lê Coil, and MFO® were 33, 32, and 21 cases respectively. Procedure and fluoroscopy time were shorter in ADO-II® compared to other groups (p=0.001 and 0.003). Complication rate was equally similar in all groups. Real cost was higher in Nit Occlud® Lê Coil compared to other groups. Negative hospital earnings was smaller in ADO-II® and MFO® groups than Nit Occlud® Lê Coil group (median -1,633,850 vs -14,006,600 vs -1,247,900 respectively), adjustment for length of stay found similar result. Adjustment by admission class found no difference of hospital earnings. Conclusion: The ADO-II® and MFO® have the smallest cost. Considering the cost-effectiveness and feasibility, ADO-II® can be chosen in small defects (<6 mm), meanwhile MFO® in larger defects. All devices described have equal success rate and complications.