Darren Mylotte1, Ruben L J Osnabrugge2, Stephan Windecker3, Thierry Lefèvre4, Peter de Jaegere2, Raban Jeger5, Peter Wenaweser3, Francesco Maisano6, Neil Moat7, Lars Søndergaard8, Johan Bosmans9, Rui C Teles10, Giuseppe Martucci11, Ganesh Manoharan12, Eulogio Garcia13, Nicolas M Van Mieghem2, A Pieter Kappetein2, Patrick W Serruys2, Ruediger Lange14, Nicolo Piazza15. 1. Department of Interventional Cardiology at McGill University Health Centre, Montreal, Quebec, Canada; Galway University Hospital, Galway, Ireland. 2. Erasmus University Medical Center, Rotterdam, the Netherlands. 3. Department of Cardiology, Bern University Hospital, Bern, Switzerland. 4. Institut Cardiovasculaire Paris Sud, Massy, France. 5. University Hospital Basel, Basel, Switzerland. 6. Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy. 7. Royal Brompton Hospital and on behalf of NICOR, London, United Kingdom. 8. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. 9. Department of Cardiology, University Hospital Antwerp, Wilrijk, Belgium. 10. Hospital de Santa Cruz, Lisbon, and on behalf of VAP APIC-SPC, Portugal. 11. Department of Interventional Cardiology at McGill University Health Centre, Montreal, Quebec, Canada. 12. Heart Centre, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom. 13. Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain. 14. Department of Cardiovascular Surgery, German Heart Center, Munich, Germany. 15. Department of Interventional Cardiology at McGill University Health Centre, Montreal, Quebec, Canada; Department of Cardiovascular Surgery, German Heart Center, Munich, Germany. Electronic address: nicolopiazza@me.com.
Abstract
OBJECTIVES: The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy. BACKGROUND: Since its commercialization in 2007, the number of TAVR procedures has grown exponentially. METHODS: The adoption of TAVR was investigated in 11 European countries: Germany, France, Italy, United Kingdom, Spain, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. Furthermore, we assessed the extent to which TAVR has penetrated its potential patient population. RESULTS: Between 2007 and 2011, 34,317 patients underwent TAVR. Considerable variation in TAVR use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 89). The weighted average TAVR penetration rate was low: 17.9%. Significant correlation was found between TAVR use and healthcare spending per capita (r = 0.80; p = 0.005). TAVR-specific reimbursement systems were associated with higher TAVR use than restricted systems (698 ± 232 vs. 213 ± 112 implants/million individuals ≥ 75 years; p = 0.002). CONCLUSIONS: The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.
OBJECTIVES: The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy. BACKGROUND: Since its commercialization in 2007, the number of TAVR procedures has grown exponentially. METHODS: The adoption of TAVR was investigated in 11 European countries: Germany, France, Italy, United Kingdom, Spain, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. Furthermore, we assessed the extent to which TAVR has penetrated its potential patient population. RESULTS: Between 2007 and 2011, 34,317 patients underwent TAVR. Considerable variation in TAVR use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 89). The weighted average TAVR penetration rate was low: 17.9%. Significant correlation was found between TAVR use and healthcare spending per capita (r = 0.80; p = 0.005). TAVR-specific reimbursement systems were associated with higher TAVR use than restricted systems (698 ± 232 vs. 213 ± 112 implants/million individuals ≥ 75 years; p = 0.002). CONCLUSIONS: The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.
Authors: Marco Di Eusanio; Francesco Saia; Giovanni Pellicciari; Kevin Phan; Marinella Ferlito; Gianni Dall'Ara; Roberto Di Bartolomeo; Antonio Marzocchi Journal: Ann Cardiothorac Surg Date: 2015-03
Authors: Aida Ribera; John Slof; Ignacio Ferreira-González; Vicente Serra; Bruno García-Del Blanco; Purificació Cascant; Rut Andrea; Carlos Falces; Enrique Gutiérrez; Raquel Del Valle-Fernández; César Morís-de laTassa; Pedro Mota; Juan Francisco Oteo; Pilar Tornos; David García-Dorado Journal: Eur J Health Econ Date: 2017-11-23
Authors: R Jansen; A M Wind; M J Cramer; F Nijhoff; P Agostoni; F Z Ramjankhan; W J Suyker; P R Stella; S A J Chamuleau Journal: Int J Cardiovasc Imaging Date: 2018-03-10 Impact factor: 2.357