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Prenatal diagnosis lowers neonatal cardiac care costs in resource-limited settings

Part of: Echocardiography

Published online by Cambridge University Press:  10 January 2022

Balu Vaidyanathan Open the ORCID record for Balu Vaidyanathan [Opens in a new window] ,
Karthika Rani ,
Farooq Kunde ,
Stephy Thomas ,
Abish Sudhakar ,
Raman Krishna Kumar Open the ORCID record for Raman Krishna Kumar [Opens in a new window]  and
Bistra Zheleva Open the ORCID record for Bistra Zheleva [Opens in a new window]
Balu Vaidyanathan*
Affiliation:
The Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, 682 041, India
Karthika Rani
Affiliation:
The Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, 682 041, India
Farooq Kunde
Affiliation:
The Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, 682 041, India
Stephy Thomas
Affiliation:
The Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, 682 041, India
Abish Sudhakar
Affiliation:
The Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, 682 041, India
Raman Krishna Kumar
Affiliation:
The Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, 682 041, India
Bistra Zheleva
Affiliation:
Childrens Heart Link, Minnesota, USA
*
Author for correspondence: Dr. Balu Vaidyanathan, Clinical Professor, Pediatric Cardiology, Head, Fetal Cardiology Division, Amrita Institute of Medical Sciences, Kochi, Kerala, 682 041, India. Tel: + 91 484 285 3570. Mobile: +91 94958 20684. Fax: +91 484 280 2020. Email: baluvaidyanathan@gmail.com
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Abstract

Background:

Prenatal diagnosis of critical CHDs and planned peripartum care is an emerging concept in resource-limited settings.

Objective:

To report the impact of prenatal diagnosis and planned peripartum care on costs of neonatal cardiac care in a resource-limited setting.

Methods:

Prospective study (October 2019 to October 2020). Consecutive neonates undergoing surgery or catheter-based interventions included. Patients were divided into prenatal (prenatal diagnosis) and post-natal (diagnosis after birth) groups. Costs of cardiac care (total, direct, and indirect) and health expenses to income ratio were compared between study groups; factors impacting costs were analysed.

Results:

A total of 105 neonates were included, including 33 in prenatal group. Seventy-seven neonates (73.3%) underwent surgical procedures while the rest needed catheter-based interventions. Total costs were 16.2% lower in the prenatal group (p = 0.008). Direct costs were significantly lower in the prenatal group (18%; p = 0.02), especially in neonates undergoing surgery (20.4% lower; p = 0.001). Health expenses to income ratio was also significantly lower in the prenatal group (2.04 (1.03–2.66) versus post-natal:2.58 (1.55–5.63), p = 0.01);, particularly in patients undergoing surgery (prenatal: 1.58 (1.03–2.66) vs. post-natal: 2.99 (1.91–6.02); p = 0.002). Prenatal diagnosis emerged as the only modifiable factor impacting costs on multivariate analysis.

Conclusion:

Prenatal diagnosis and planned peripartum care of critical CHD is feasible in resource-limited settings and is associated with significantly lower costs of neonatal cardiac care. The dual benefit of improved clinical outcomes and lower costs of cardiac care should encourage policymakers in resource-limited settings towards developing more prenatal cardiac services.

Keywords

Prenatal diagnosisPlanned peripartum careCostsResource-limited settings
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 11 , November 2022 , pp. 1754 - 1760
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Van Der Linde, D, Konings, EEM, Slager, MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011; 58: 2241–2247.CrossRefGoogle ScholarPubMed
Zimmerman, MS, Smith, AGC, Sable, CA, Zheleva, B, Martin, GR, for Kassebaum N.J., GBD. congenital heart disease collaborators. global, regional, and national burden of congenital heart disease, 1990-2017: a systematic analysis for the Global burden of disease study 2017. Lancet 2017; 4: 185–200, 2020.Google Scholar
Gilboa, SM, Salemi, JL, Nembhard, WN, Fixler, DE, Correa, A. Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006. Circulation 2010; 122: 2254–2263.CrossRefGoogle ScholarPubMed
Villafane, J, Lantin-Hermoso, R, Bhatt. AB, etal, D-Transposition of the great arteries. the current era of the arterial switch operation. J Am Coll Cardiol 2014; 64: 498–511.Google Scholar
Musa, NL, Hjortdal, V, Zheleva, B, et al. The global burden of congenital heart disease. Cardiol Young 2017; 27: S3–S8.CrossRefGoogle Scholar
Kumar, RK, Shrivastava, S. Pediatric heart care in India. Heart 2008; 94: 984–990.CrossRefGoogle ScholarPubMed
Raj, M, Paul, M, Sudhakar, A, et al. Micro-economic impact of congenital heart surgery: results of a prospective study from a limited-resource setting. PLoS ONE 2015; 10: e0131348. DOI 10.1371/journal.pone.0131348.CrossRefGoogle ScholarPubMed
Reddy, NS, Kappanayil, M, Balachandran, R, et al. Preoperative determinants of outcomes of infant heart surgery in a limited-resource setting. Semin. Thor. Surg 2015; 27: 331–338.Google Scholar
Jenkins, KJ, Casteneda, AR, Cherian, KM, et al. Reducing mortality and infections after congenital heart surgery in the developing world. Pediatrics 2014; 134: e1422–30.CrossRefGoogle ScholarPubMed
Everwijn, SMP, van Nisselrooij, AEL, Rozendaal, L, et al. The effect of the introduction of the three-vessel view on the detection rate of transposition of great arteries and tetralogy of fallot. Prenat Diagn 2018; 38: 951–957.CrossRefGoogle ScholarPubMed
Hunter, S, Heads, A, Wyllie, J, Robson, S. Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training programme for obstetric sonographers. Heart 2000; 84: 294–298.CrossRefGoogle Scholar
Simpson, JM. Impact of fetal echocardiography. Ann Pediatric Card 2009; 2: 41–50.CrossRefGoogle ScholarPubMed
Holland, BJ, Myers, JA, Woods, CR Jr. Prenatal diagnosis of critical congenital heart disease reduces risk of death from cardiovascular compromise prior to planned neonatal cardiac surgery: a meta-analysis. Ultrasound Obstet Gynecol 2015; 45: 631–638.CrossRefGoogle ScholarPubMed
Thakur, V, Dutil, N, Schwartz, SM, Jaeggi, E. Impact of prenatal diagnosis on the management and early outcome of critical duct-dependent cardiac lesions. Cardiol Young 2018; 28: 548–553.CrossRefGoogle ScholarPubMed
Quartermain, MD, Hill, KD, Goldberg, DJ, et al. Prenatal diagnosis influences preoperative status in neonates with congenital heart disease: an analysis of the society of thoracic surgeons congenital heart surgery database. Pediatr Cardiol 2018 Oct 19, 10.1007/s00246-018-1995-4.Google Scholar
Cloete, E, Bloomfield, FH, Sadler, L, de Laat, MWM, Finucane, K, Gentles, TL. Antenatal detection of treatable critical congenital heart disease is associated with lower morbidity and mortality. J Pediatr 2019; 204: 66–70.CrossRefGoogle ScholarPubMed
Karmegaraj, B, Kappanayil, Sudhakar, Kumar, A, RK. Impact of transport on arrival status and outcomes in newborns with heart disease: a low-middle-income country perspective. Cardiol Young 2020; 30: 1001–1008.CrossRefGoogle ScholarPubMed
Vijayaraghavan, A, Sudhakar, A, Sundaram, KR, Kumar, RK, Vaidyanathan, B. Prenatal diagnosis and planned peri-partum care as a strategy to improve preoperative status in neonates with critical CHDs in low-resource settings: a prospective study. Cardiol Young 2019; 12: 1481–1488.CrossRefGoogle Scholar
Gupta, D, Mowitz, ME, Lopez-Colon, D, Nixon, CS, Vyas, HV, Co-Vu, JG. Effect of prenatal diagnosis on hospital costs in complete transposition of the great arteries prenat diagn, 10.1002/pd.5271.Google Scholar
Changlani, TD, Jose, A, Sudhakar, A, Rojal, R, Kunjikutty, R, Vaidyanathan, B. Outcomes of infants with prenatally diagnosed congenital heart disease delivered in a pediatric cardiac facility. Indian Pediatr 2015; 52: 852–856.CrossRefGoogle Scholar
Rashtriya Bal Swasthya Karyakram (RBSK). Ministry of health and family welfare, government of India, Available at: https://nhm.gov.in/index1.php?lang=1&level=4&sublinkid=1190&lid=583, Accessed 28th April 2021.Google Scholar
National health mission - Hridyam for little hearts., Available at: https://hridyam.kerala.gov.in/, Accessed 27th April 2021.Google Scholar
Sharma, R. Revised kuppuswamy’s socioeconomic status scale: explained and updated. Indian Pediatr 2017; 54: 867–870.CrossRefGoogle Scholar
Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semi Thorac Cardiovasc Surg 2004; 7: 80–84.Google ScholarPubMed
Kunde, F, Thomas, S, Sudhakar, A, Kunjikutty, R, Kumar, RK, Vaidyanathan, B. Prenatal diagnosis and planned peri-partum care improves perinatal outcomes in fetuses with transposition with intact septum in low-resource settings. Ultrasound Obstet Gynecol Oct 2020, 10.1002/uog.23146.Google Scholar
Carvalho, JS, Allan, LD, Chaoui, R, et al. ISUOG practice guidelines(updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol 2013; 41: 348–359.CrossRefGoogle Scholar
Roberts, T, Henderson, J, Mugford, M, Bricker, L, Neilson, J, Garcia, J. Antenatal ultrasound screening for fetal abnormalities: a systematic review of studies of cost and cost effectiveness. BJOG 2002; 109: 44–56.CrossRefGoogle ScholarPubMed
Pinto, NM, Nelson, R, Puchalski, M, Metz, TD, Smith, KJ. Cost-effectiveness of prenatal screening strategies for congenital heart disease. Ultrasound Obstet Gynecol 2014; 44: 50–57.CrossRefGoogle ScholarPubMed
Evans, W, Castillo, W, Rollins, R, et al. Moving towards universal prenatal detection of critical congenital heart disease in southern Nevada: a community-wide program. Pediatr Cardiol 2015; 36: 281–288.CrossRefGoogle ScholarPubMed
Donofrio, MT, Moon-Grady, AJ, Hornberger, LK, et al. American heart association adults with congenital heart disease joint committee of the council on cardiovascular disease in the young and council on clinical cardiology, council on cardiovascular surgery and anesthesia, and council on cardiovascular and stroke nursing. diagnosis and treatment of fetal cardiac disease: a scientific statement from the american heart association. Circulation 2014; 129: 2183–2242.CrossRefGoogle Scholar
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