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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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