Anja Gutmann1, Klaus Kaier2, Stefan Sorg3, Constantin von Zur Mühlen1, Matthias Siepe3, Martin Moser1, Annette Geibel1, Andreas Zirlik1, Ingo Ahrens1, Hardy Baumbach4, Friedhelm Beyersdorf1, Werner Vach5, Manfred Zehender1, Christoph Bode1, Jochen Reinöhl1. 1. Department of Cardiology and Angiology I, Heart Center Freiburg University, Germany. 2. Department of Cardiology and Angiology I, Heart Center Freiburg University, Germany; Center for Medical Biometry and Medical Informatics, Medical Center, University of Freiburg, Germany. Electronic address: kaier@imbi.uni-freiburg.de. 3. Department of Cardiovascular Surgery, Heart Center Freiburg University, Germany. 4. Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Germany. 5. Center for Medical Biometry and Medical Informatics, Medical Center, University of Freiburg, Germany.
Abstract
BACKGROUND: This study aims at analyzing complication-induced additional costs of patients undergoing transcatheter aortic valve replacement (TAVR). METHODS: In a prospective observational study, a total of 163 consecutive patients received either transfemoral (TF-, n=97) or transapical (TA-) TAVR (n=66) between February 2009 and December 2012. Clinical endpoints were categorized according to VARC-2 definitions and in-hospital costs were determined from the hospital perspective. Finally, the additional costs of complications were estimated using multiple linear regression models. RESULTS: TF-TAVR patients experienced significantly more minor access site bleeding, major non-access site bleeding, minor vascular complications, stage 2 acute kidney injury (AKI) and permanent pacemaker implantation. Total in-hospital costs did not differ between groups and were on average €40,348 (SD 15,851) per patient. The average incremental cost component of a single complication was €3438 (p<0.01) and the estimated cost of a TF-TAVR without complications was €34,351. The complications associated with the highest additional costs were life-threatening non-access site bleeding (€47,494; p<0.05), stage 3 AKI (€20,468; p<0.01), implantation of a second valve (€16,767; p<0.01) and other severe cardiac dysrhythmia (€10,611 p<0.05). Overall, the presence of complication-related in-hospital mortality increased costs. CONCLUSIONS: Bleeding complications, severe kidney failure, and implantation of a second valve were the most important cost drivers in our TAVR patients. Strategies and advances in device design aimed at reducing these complications have the potential to generate significant in-hospital cost reductions for the German Health Care System.
BACKGROUND: This study aims at analyzing complication-induced additional costs of patients undergoing transcatheter aortic valve replacement (TAVR). METHODS: In a prospective observational study, a total of 163 consecutive patients received either transfemoral (TF-, n=97) or transapical (TA-) TAVR (n=66) between February 2009 and December 2012. Clinical endpoints were categorized according to VARC-2 definitions and in-hospital costs were determined from the hospital perspective. Finally, the additional costs of complications were estimated using multiple linear regression models. RESULTS: TF-TAVR patients experienced significantly more minor access site bleeding, major non-access site bleeding, minor vascular complications, stage 2 acute kidney injury (AKI) and permanent pacemaker implantation. Total in-hospital costs did not differ between groups and were on average €40,348 (SD 15,851) per patient. The average incremental cost component of a single complication was €3438 (p<0.01) and the estimated cost of a TF-TAVR without complications was €34,351. The complications associated with the highest additional costs were life-threatening non-access site bleeding (€47,494; p<0.05), stage 3 AKI (€20,468; p<0.01), implantation of a second valve (€16,767; p<0.01) and other severe cardiac dysrhythmia (€10,611 p<0.05). Overall, the presence of complication-related in-hospital mortality increased costs. CONCLUSIONS:Bleeding complications, severe kidney failure, and implantation of a second valve were the most important cost drivers in our TAVR patients. Strategies and advances in device design aimed at reducing these complications have the potential to generate significant in-hospital cost reductions for the German Health Care System.
Authors: Klaus Kaier; Holger Reinecke; Huseyin Naci; Lutz Frankenstein; Martin Bode; Werner Vach; Philip Hehn; Andreas Zirlik; Manfred Zehender; Jochen Reinöhl Journal: Eur J Health Econ Date: 2017-02-22
Authors: Klaus Kaier; Frederike von Kampen; Hardy Baumbach; Constantin von Zur Mühlen; Philip Hehn; Werner Vach; Manfred Zehender; Christoph Bode; Jochen Reinöhl Journal: BMC Health Serv Res Date: 2017-07-11 Impact factor: 2.655
Authors: Harindra C Wijeysundera; Lindsay Li; Vevien Braga; Nandhaa Pazhaniappan; Anar M Pardhan; Dana Lian; Aric Leeksma; Ben Peterson; Eric A Cohen; Anne Forsey; Kori J Kingsbury Journal: Open Heart Date: 2016-08-16
Authors: Sabine Engler-Hüsch; Thomas Heister; Nico T Mutters; Jan Wolff; Klaus Kaier Journal: BMC Health Serv Res Date: 2018-09-26 Impact factor: 2.655