Andrew M Goldsweig1, Hyo Jung Tak2, Li-Wu Chen2, Herbert D Aronow3, Binita Shah4, Dhaval Kolte5, Nihar R Desai6, Molly Szerlip7, Poonam Velagapudi1, J Dawn Abbott3. 1. Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha. (A.M.G., P.V.). 2. Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha. (H.J.T., L.-W.C.). 3. Division of Cardiovascular Medicine, Lifespan Cardiovascular Institute, Brown University, Providence, RI (H.D.A., J.D.A.). 4. Division of Cardiology, VA New York Harbor Healthcare and New York University School of Medicine (B.S.). 5. Division of Cardiovascular Medicine, Harvard University, Massachusetts General Hospital, Boston (D.K.). 6. Division of Cardiovascular Medicine, Yale University, Yale New Haven Hospital, New Haven, CT (N.R.D.). 7. Department of Interventional Cardiology, The Heart Hospital, Baylor Plano, Plano, TX (M.S.).
Abstract
BACKGROUND: The number of patients treated for aortic valve disease in the United States is increasing rapidly. Transcatheter aortic valve replacement (TAVR) is supplanting surgical aortic valve replacement (SAVR) and medical therapy (MT). The economic implications of these trends are unknown. Therefore, we undertook to determine the costs, inpatient days, and number of admissions associated with treating aortic valve disease with SAVR, TAVR, or MT. METHODS: Using the Nationwide Readmissions Database, we identified patients with aortic valve disease admitted 2012 to 2016 for SAVR, TAVR, and disease symptoms (congestive heart failure, unstable angina, non-ST-elevation myocardial infarction, syncope). Patients not undergoing SAVR or TAVR were classified as receiving MT. Beginning with the index admission, we estimated inpatient costs, days, and admissions over 6 months. RESULTS: Among 190 563 patients with aortic valve disease, the average aggregate 6-month inpatient costs were $59 743 for SAVR, $64 395 for TAVR, and $23 460 for MT. Mean index admission was longer for SAVR (10.0 days) than for TAVR (7.0 day) or MT (5.3 days), but the average number of unplanned readmission inpatient days was 2.0 for SAVR, 3.0 for TAVR, and 4.3 for MT; the average number of total admissions was 1.3 for SAVR, 1.5 for TAVR, and 1.7 for MT (P<0.01 for all). TAVR index admission costs decreased over time to become similar to SAVR costs by 2016. CONCLUSIONS: Aggregate costs were higher for TAVR than SAVR and were significantly more expensive than MT alone. However, TAVR costs decreased over time while SAVR and MT costs remained unchanged.
BACKGROUND: The number of patients treated for aortic valve disease in the United States is increasing rapidly. Transcatheter aortic valve replacement (TAVR) is supplanting surgical aortic valve replacement (SAVR) and medical therapy (MT). The economic implications of these trends are unknown. Therefore, we undertook to determine the costs, inpatient days, and number of admissions associated with treating aortic valve disease with SAVR, TAVR, or MT. METHODS: Using the Nationwide Readmissions Database, we identified patients with aortic valve disease admitted 2012 to 2016 for SAVR, TAVR, and disease symptoms (congestive heart failure, unstable angina, non-ST-elevation myocardial infarction, syncope). Patients not undergoing SAVR or TAVR were classified as receiving MT. Beginning with the index admission, we estimated inpatient costs, days, and admissions over 6 months. RESULTS: Among 190 563 patients with aortic valve disease, the average aggregate 6-month inpatient costs were $59 743 for SAVR, $64 395 for TAVR, and $23 460 for MT. Mean index admission was longer for SAVR (10.0 days) than for TAVR (7.0 day) or MT (5.3 days), but the average number of unplanned readmission inpatient days was 2.0 for SAVR, 3.0 for TAVR, and 4.3 for MT; the average number of total admissions was 1.3 for SAVR, 1.5 for TAVR, and 1.7 for MT (P<0.01 for all). TAVR index admission costs decreased over time to become similar to SAVR costs by 2016. CONCLUSIONS: Aggregate costs were higher for TAVR than SAVR and were significantly more expensive than MT alone. However, TAVR costs decreased over time while SAVR and MT costs remained unchanged.
Authors: Mourad H Senussi; John Schindler; Ibrahim Sultan; Ahmad Masri; Forozan Navid; Dustin Kliner; Arman Kilic; Michael S Sharbaugh; Amr Barakat; Andrew D Althouse; Joon S Lee; Thomas G Gleason; Suresh R Mulukutla Journal: Cardiovasc Diagn Ther Date: 2021-08
Authors: Matthias Schindler; Florin Stöckli; Rico Brütsch; Philipp Jakob; Erik Holy; Jonathan Michel; Robert Manka; Paul Vogt; Christian Templin; Markus Kasel; Frank Ruschitzka; Barbara E Stähli Journal: J Am Heart Assoc Date: 2021-10-29 Impact factor: 5.501