Alireza Ahmadi - Assistant Professor, Isfahan Cardiovascular Research Centre, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Mohammadreza Sabri - Professor, Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Hamid Bigdelian - Assistant Professor, Division of Cardiovascular Surgery , Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Bahar Dehghan - Fellow of Pediatric Cardiology, Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Mojgan Gharipour - PhD Candidate, Cardiac Rehabilitation Research Centre, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

BACKGROUND: Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA). Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. METHODS: In this cross-sectional study, a randomized sample of ۲۰۱ patients aged ۱ month to ۱۶ years (۱۰۵ patients with device closure and ۹۶ patients with surgical closure) was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. RESULTS: There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (۲.۱ ± ۰.۷ versus ۱.۷ ± ۰.۶, P = ۰.۰۹۰). The mean measured costs were overall higher in the device closure group than in open closure group (۹۴۸.۸۷ ± ۵۴۸.۷۶ US versus ۷۴۳.۷۰ ± ۶۹۶.۹۱ US, P < ۰.۰۰۱). This difference remained significant after adjustment for age and gender (Standardized Beta = ۰.۱۶۰, P = ۰.۰۳۱). PDA closure with the Amplatzer ductal occluder (۱۰۵۳.۰۵ ± ۵۲۵.۷۳ US) or with Nit-Occlud coils (PFM) (۹۱۲.۷۳ ± ۵۶۵.۹۴ US, P < ۰.۰۰۱) was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (۶۰۵.۶۵ ± ۱۹۴.۶۲ US, P = ۰.۶۵۰) had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, ۲ in-hospital deaths occurred, two patients experienced pneumonia and seizure, and one suffered electrolyte abnormalities including hyponatremia and hypocalcemia. CONCLUSION: Although open surgery seems to be less expensive than device closure technique, because of lower mortality and morbidity, the latter group is more preferable.   Keywords: Cost-effectiveness, Outcome, Device Closure, Open Surgery Closure, Patent Ductus Arteriosus