Neel M Butala1, David A Wood2, Haiyan Li3, Khaja Chinnakondepalli3, Sandra B Lauck2, Janarthanan Sathananthan2, John A Cairns2, Elizabeth A Magnuson3, Madeleine Barker2, John G Webb2, Robert Welsh4, Anson Cheung2, Jian Ye2, James L Velianou5, Harindra C Wijeysundera6, Anita Asgar7, Susheel Kodali8, Vinod H Thourani9, David J Cohen10,11. 1. Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (N.M.B.). 2. Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada (D.A.W., S.B.L., J.S., J.A.C., M.B., J.G.W., A.C., J.Y.). 3. St Luke's Mid-America Heart Institute, Kansas City, MO (H.L., K.C., E.A.M.). 4. Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (R.W.). 5. Division of Cardiology, Department of Medicine, Hamilton Health Sciences, McMaster University, Ontario, Canada (J.L.V.). 6. Division of Cardiology, Department of Medicine, University of Toronto, Canada (H.C.W.). 7. Montreal Heart Institute, Quebec, Canada (A.A.). 8. Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (S.K.). 9. Piedmont Heart Institute, Atlanta, GA (V.H.T.). 10. Cardiovascular Research Foundation, New York, NY (D.J.C.). 11. St Francis Hospital and Heart Center, Roslyn, NY (D.J.C.).
Abstract
BACKGROUND: The 3M-TAVR trial (3M-Transcatheter Aortic Valve Replacement) demonstrated the feasibility and safety of next-day hospital discharge after transfemoral TAVR with implementation of a minimalist pathway. However, the economic impact of this approach is unknown. Therefore, we evaluated costs for patients undergoing minimalist TAVR compared with conventional TAVR. METHODS: We used propensity matching to compare resource utilization and costs (from a US health care system perspective) for patients in the 3M-TAVR trial with those for transfemoral TAVR patients enrolled in the contemporaneous S3i trial (PARTNER SAPIEN-3 Intermediate Risk). Procedural costs were estimated using measured resource utilization for both groups. For the S3i group, all other costs through 30-day follow-up were assessed by linkage with Medicare claims; for 3M, these costs were assessed using regression models derived from S3i cost and resource utilization data. RESULTS: After 1:1 propensity matching, 351 pairs were included in our study (mean age 82, mean Society of Thoracic Surgery risk score 5.3%). There were no differences in death, stroke, or rehospitalization between the 3M-TAVR and S3i groups through 30-day follow-up. Index hospitalization costs were $10 843/patient lower in the 3M-TAVR cohort, driven by reductions in procedure duration, anesthesia costs, and length of stay. Between discharge and 30 days, costs were similar for the 2 groups such that cumulative 30-day costs were $11 305/patient lower in the 3M-TAVR cohort compared with the S3i cohort ($49 425 versus $60 729, 95% CI for difference $9378 to $13 138; P<0.001). CONCLUSIONS: Compared with conventional transfemoral TAVR, use of a minimalist pathway in intermediate-risk patients was associated with similar clinical outcomes and substantial in-hospital cost savings, which were sustained through 30 days. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02287662.
BACKGROUND: The 3M-TAVR trial (3M-Transcatheter Aortic Valve Replacement) demonstrated the feasibility and safety of next-day hospital discharge after transfemoral TAVR with implementation of a minimalist pathway. However, the economic impact of this approach is unknown. Therefore, we evaluated costs for patients undergoing minimalist TAVR compared with conventional TAVR. METHODS: We used propensity matching to compare resource utilization and costs (from a US health care system perspective) for patients in the 3M-TAVR trial with those for transfemoral TAVR patients enrolled in the contemporaneous S3i trial (PARTNER SAPIEN-3 Intermediate Risk). Procedural costs were estimated using measured resource utilization for both groups. For the S3i group, all other costs through 30-day follow-up were assessed by linkage with Medicare claims; for 3M, these costs were assessed using regression models derived from S3i cost and resource utilization data. RESULTS: After 1:1 propensity matching, 351 pairs were included in our study (mean age 82, mean Society of Thoracic Surgery risk score 5.3%). There were no differences in death, stroke, or rehospitalization between the 3M-TAVR and S3i groups through 30-day follow-up. Index hospitalization costs were $10 843/patient lower in the 3M-TAVR cohort, driven by reductions in procedure duration, anesthesia costs, and length of stay. Between discharge and 30 days, costs were similar for the 2 groups such that cumulative 30-day costs were $11 305/patient lower in the 3M-TAVR cohort compared with the S3i cohort ($49 425 versus $60 729, 95% CI for difference $9378 to $13 138; P<0.001). CONCLUSIONS: Compared with conventional transfemoral TAVR, use of a minimalist pathway in intermediate-risk patients was associated with similar clinical outcomes and substantial in-hospital cost savings, which were sustained through 30 days. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02287662.
Entities:
Keywords:
Medicare; costs and cost analysis; hospital; hospitalization; length of stay; transcatheter aortic valve replacement
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