OBJECTIVES: To quantify total healthcare resource utilization (HCRU) costs for patients with obstructive hypertrophic cardiomyopathy (oHCM) receiving septal myectomy (SM) or alcohol septal ablation (ASA).

METHODS: Retrospective study utilizing medical and pharmacy claims data representing >50 million US commercially insured and Medicare Advantage members from the HealthCore Integrated Research Database during 2013-2019. Direct medical costs included inpatient, outpatient, emergency department, and pharmacy (2019 $ US) and were the sum of plan paid, patient paid, and any coordination of benefit. HCRU costs were captured for ≥1 SM or ASA procedure for oHCM patients (≥18 years) and reported 12-months pre- and post-procedure.

RESULTS: Of 119 identified patients, 95 (80%) received SM. Mean length of inpatient hospitalization stay was longer for SM (8.3 days) than ASA (6 days). Post-surgery HCM-related medication usage was greater for SM (98%) than ASA (88%). Mean number of outpatient visits increased from pre- to post-surgery (SM=12.2 vs 15.9; ASA=7.2 vs 9.5), with 86% of SM and 83% of ASA patients having ≥1 cardiology visit. Compared to the pre-surgery, total HCM-related costs increased during post-surgery period, index surgery inclusive (SM=$27,045 vs $119,772; ASA=$11,278 vs $54,351), driven by increased inpatient hospitalization (SM=$10,325 vs $112,923; ASA=$5,509 vs $47,450) and surgical cost (SM=$6,665 vs $92,031; ASA=$52 vs $44,815). For pre-SM vs post-SM, HCM-related medication costs decreased ($974 vs $744) along with outpatient visit costs ($14,202 vs $5,782); for ASA, HCM-related medication ($827 vs $1,201) and outpatient visit costs increased ($4,645 vs $5,431).

CONCLUSIONS: Our results indicate a trend towards increasing costs after septal reduction therapy, driven mostly by inpatient hospitalization and surgical costs. All outpatient costs decreased after myectomy, while only diagnostic cost decreased in the ablation group. HCRU increased after surgery for both groups, with length of stay and HCM-related medication use being higher in SM.