Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation

Abstract

ObjectiveTranscatheter aortic valve implantation (TAVI) is generally more expensive than surgical aortic valve replacement (SAVR) due to the high cost of the device. Our objective was to understand the patient and procedural drivers of cumulative healthcare costs during the index hospitalisation for these procedures.DesignAll patients undergoing TAVI, isolated SAVR or combined SAVR+coronary artery bypass grafting (CABG) at 7 hospitals in Ontario, Canada were identified during the fiscal year 2012–2013. Data were obtained from a prospective registry. Cumulative healthcare costs during the episode of care were determined using microcosting. To identify drivers of healthcare costs, multivariable hierarchical generalised linear models with a logarithmic link and γ distribution were developed for TAVI, SAVR and SAVR+CABG separately.ResultsOur cohort consisted of 1310 patients with aortic stenosis, of whom 585 underwent isolated SAVR, 518 had SAVR+CABG and 207 underwent TAVI. The median costs for the index hospitalisation for isolated SAVR were $21 811 (IQR $18 148–$30 498), while those for SAVR+CABG were $27 256 (IQR $21 741–$39 000), compared with $42 742 (IQR $37 295–$56 196) for TAVI. For SAVR, the major patient-level drivers of costs were age >75 years, renal dysfunction and active endocarditis. For TAVI, chronic lung disease was a major patient-level driver. Procedural drivers of cost for TAVI included a non-transfemoral approach. A prolonged intensive care unit stay was associated with increased costs for all procedures.ConclusionsWe found wide variation in healthcare costs for SAVR compared with TAVI, with different patient-level drivers as well as potentially modifiable procedural factors. These highlight areas of further study to optimise healthcare delivery.

Transcatheter valve‐in‐valve versus redo surgical aortic valve replacement for the treatment of degenerated bioprosthetic aortic valve: A systematic review and meta‐analysis

“…This meta‐analysis is the first to directly compare redo SAVR to ViV for failed aortic bioprostheses and provide pooled results for an extensive set of outcomes: early and late mortality outcomes, clinically important complications, hemodynamics and hospital and ICU length of stay. The cost‐effectiveness of transcatheter valve technology remains highly relevant; decreased hospital and ICU length of stay in the ViV group may have important economic implications .…”

Short Length of Stay After Elective Transfemoral Transcatheter Aortic Valve Replacement is Not Associated With Increased Early or Late Readmission Risk

“…Furthermore, TAVR remains costly, and despite the growing number of suitable candidates for intervention, it remains restricted to specialized tertiary care centers. Given that a substantial portion of the costs associated with TAVR are incurred during the time spent in‐hospital after the index procedure, shortening post‐TAVR length of stay holds promise in reducing costs and improving the efficiency of care without compromising quality of care, namely early readmission . Lastly, the high observed 30‐day (13.5%) and 1‐year (44.0%) readmission rates noted in elective cases highlights the need to develop strategies aimed at reducing readmission risk such as postdischarge transitional care and early physician follow‐up …”

“…There are a paucity of data on the relationship between length of stay post‐TAVR and readmission. Shortening length of stay is attractive to healthcare systems given that it may potentially reduce adverse outcomes and TAVR‐related costs given that a substantial burden of the cost of TAVR is incurred after the index procedure . Accordingly, we conducted a retrospective multicenter cohort study of elective patients undergoing transfemoral TAVR in Ontario, Canada, in order to determine the relationship between length of stay and readmission risk.…”

“…Shortening length of stay is attractive to healthcare systems given that it may potentially reduce adverse outcomes and TAVR-related costs given that a substantial burden of the cost of TAVR is incurred after the index procedure. 12 Accordingly, we conducted a retrospective multicenter cohort study of elective patients undergoing transfemoral TAVR in Ontario, Canada, in order to determine the relationship between length of stay and readmission risk. Specifically, we sought to determine whether the relationship was nonlinear and hypothesized that it was U-shaped with an increased readmission risk with both short and long lengths of stay.…”

Effect of procedural refinement of transfemoral transcatheter aortic valve implantation on outcomes and costs: a single-centre retrospective study

“…Pressure on healthcare resources means that in addition to optimising outcomes it is important to develop treatment strategies that are cost-effective. Most of the costs associated with the index episode of care for TAVI relate to procedural/hospital-related factors 44. In particular, a prolonged stay in the ICU is associated with increased costs,44 and periprocedural complications can prolong length of stay and increase costs 45.…”