Bridging the Gap: Why Cost-Effectiveness Analyses of Congenital Heart Interventions Are Critical for Person-Centered Value-Based Care
Author(s)
Salma Pardhan, MPH, MA1, Philip Moons, PhD2, Zacharias Mandalenakis, PhD, MD3, Junaid Jawed, MPH4, Isa van Boekel, MPH4, Hanna Gyllensten, PhD1.
1Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden, 2Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium, 3Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden, 4Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
1Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden, 2Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium, 3Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden, 4Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
OBJECTIVES: To illustrate the underutilization of cost-effectiveness evaluations in congenital heart disease (CHD) care and to demonstrate, through case studies on atrial (ASD) and ventricular septal defect (VSD) repair, how the lack of standardized effectiveness data hinders patient-centered, value-based healthcare planning.
METHODS: Two decision-analytic models were developed to compare surgical and transcatheter repair for ASD and VSD. Systematic literature reviews and meta-analyses were conducted to extract cost and effectiveness data, with all costs standardized to 2025 International Dollars (INT$). For the ASD model, effectiveness was measured using QALYs sourced from external literature; for VSD, effectiveness was defined by the probability of avoiding complications due to the absence of utility-based outcomes. Both models were subjected to deterministic sensitivity analyses.
RESULTS: For ASD repair, transcatheter closure offered a QALY gain of 0.107 at an incremental cost of 1,326 INT$, yielding an ICER of 12,400 INT$ per QALY—well below standard cost-effectiveness thresholds. In the VSD model, transcatheter repair demonstrated slightly higher effectiveness (97.44% vs. 94.97%) and cost, with an ICER of 3,190 INT$ per complication avoided. Across both models, availability of QALY data was limited. The ASD analysis relied on a single adult-focused study; no utility-based outcomes were available for VSD, despite high pediatric prevalence. Neither model included societal costs or long-term follow-up expenses.
CONCLUSIONS: These findings affirm the feasibility and importance of conducting economic evaluations in CHD care but expose major gaps in effectiveness data, particularly for pediatric populations. The lack of standardized, life-course metrics undermines shared decision-making and limits value-based policy development. Expanding cost-effectiveness research with person-centered outcomes is critical to advancing equitable, sustainable CHD care.
METHODS: Two decision-analytic models were developed to compare surgical and transcatheter repair for ASD and VSD. Systematic literature reviews and meta-analyses were conducted to extract cost and effectiveness data, with all costs standardized to 2025 International Dollars (INT$). For the ASD model, effectiveness was measured using QALYs sourced from external literature; for VSD, effectiveness was defined by the probability of avoiding complications due to the absence of utility-based outcomes. Both models were subjected to deterministic sensitivity analyses.
RESULTS: For ASD repair, transcatheter closure offered a QALY gain of 0.107 at an incremental cost of 1,326 INT$, yielding an ICER of 12,400 INT$ per QALY—well below standard cost-effectiveness thresholds. In the VSD model, transcatheter repair demonstrated slightly higher effectiveness (97.44% vs. 94.97%) and cost, with an ICER of 3,190 INT$ per complication avoided. Across both models, availability of QALY data was limited. The ASD analysis relied on a single adult-focused study; no utility-based outcomes were available for VSD, despite high pediatric prevalence. Neither model included societal costs or long-term follow-up expenses.
CONCLUSIONS: These findings affirm the feasibility and importance of conducting economic evaluations in CHD care but expose major gaps in effectiveness data, particularly for pediatric populations. The lack of standardized, life-course metrics undermines shared decision-making and limits value-based policy development. Expanding cost-effectiveness research with person-centered outcomes is critical to advancing equitable, sustainable CHD care.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE77
Topic
Economic Evaluation, Medical Technologies, Patient-Centered Research
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Pediatrics