Economic Impact of Echocardiography Use in the Follow-Up of Small and Small to Moderate Size Muscular Ventricular Septal Defects.

Follow-up echocardiograms are not recommended for small and small to moderate size muscular ventricular septal defects (mVSDs). Our purpose in this single center retrospective cohort study was to describe practice variation in echocardiogram utilization in the follow-up of small and small to moderate mVSDs diagnosed at ≤ 6 months of age and assess factors associated with variation. Demographic and provider data were collected. Patients with ≥ 1 follow-up echocardiogram formed the Overutilization Group and those with no follow-up echocardiogram the Appropriate Utilization Group. Of 414 patients, 153 (37%) had ≥ 1 follow-up echocardiogram (overutilization). There were no significant differences in sex, race, ethnicity, or preferred language. The Overutilization Group was marginally more likely to have private insurance (68% vs. 55%, p = 0.06) and a higher National Child Opportunity Index (56% vs. 44% high or very high, p = 0.02). In the Overutilization Group, VSD murmurs were documented in 45% and a VSD was still present on echocardiogram in 56%. Based on costs of echocardiograms at our institution and distribution of private vs. publicly insured patients, which both vary by institution, the estimated annual expenditure in the U.S. would exceed 20 million dollars on imaging that does not impact clinical course or outcomes. Echocardiography was overutilized in the follow-up of over 1/3 of patients, with documented planned echocardiograms increasing this to almost ½ of the cohort. Decreasing overutilization of echocardiograms in the follow-up of these patients could result in significant savings to the healthcare system without compromising patient outcomes.