Transcatheter amplatzer occlusion and surgical closure of patent ductus arteriosus: comparison of effectiveness and costs in a low-income country.

The goal of this study was to compare the effectiveness and cost of transcatheter Amplatzer occlusion with those of surgical closure for patent ductus arteriosus (PDA) in a low-income country, China. Although transcatheter Amplatzer occlusion for PDA has been increasingly performed, surgical PDA closure is still a routine procedure at many hospitals in China. Therefore, the selection of treatment modality for patients with PDA who could undergo either treatment option is controversial. The treatment of patients with PDA from February 2005 to February 2007 was analyzed retrospectively. A total of 130 patients underwent surgical closure for PDA, whereas 51 patients underwent Amplatzer occlusion. There were no deaths and no residual left-to-right shunting in either group at last follow-up. In total, 2% of patients with complications requiring management underwent Amplatzer device closure and 6.2% surgical closure. The mean hospital stay was 3.6 +/- 1.5 days for the device group and 8.8 +/- 2.3 days for the surgical group (p < 0.001). The cost with surgical closure was 26% less than that with Amplatzer device closure (13,841.2 +/- 3630.3 vs. 18,708.7 +/- 1816.5 Renminbi [Chinese currency]; p < 0.001). In conclusion, although transcatheter Amplatzer device occlusion is as effective as and less invasive than surgical closure for PDA, surgical closure is less costly. In low-income countries such as China, where health-care resources are limited, PDA closure with the Amplatzer duct occluder device is not cost-effective.