The waiting game: Delaying TAVR increases healthcare costs by $10K per year
Delaying transcatheter aortic valve replacement (TAVR) in eligible patients with severe aortic stenosis (AS) can lead to much higher healthcare costs, according to new data published in Structural Heart.[1]
“Even with broader indications since the advent of TAVR, it is estimated that up to two-thirds of patients with symptomatic, severe AS who are not offered treatment due to various reasons, including incomplete heart team evaluation or misinterpretation of severity, are appropriate candidates for aortic valve replacement,” wrote first author Ankur Sethi, MD, a cardiologist with Robert Wood Johnson University Hospital, and colleagues. “And even among those who are treated, for a variety of reasons, including failure to diagnose, delays in referral, patient hesitancy and a lack of programmatic bandwidth to process patients, treatment is often delayed.”
Sethi et al. examined data from an Optum Medicare Advantage (MA) database, tracking more than 150,000 real-world AS patients aged 65 years old or older. All patients had a record of syncope, dyspnea, fatigue, chest pain/angina or heart failure prior to or within 30 days of being diagnosed with AS. Patients who needed an immediate TAVR were excluded.
The researchers evaluated total healthcare costs over a full two-year period. To help learn more about each patient’s comorbidities, individuals were only included in the study if recent echocardiography findings were available for review.
Overall, when adjusting for various demographics and comorbidities, delaying TAVR in patients with clinically significant AS was associated with a rise in healthcare costs of $28 per day, or $10,080 per year. Patients who were men or a race other than white were also linked to higher costs. This increase in costs is largely related to non-TAVR costs. The costs of the actual TAVR hospitalization are not significantly impacted by whether or not TAVR is delayed or prompt.
The study’s authors also noted that delayed TAVR was associated with a higher risk of two-year mortality compared to prompt TAVR. Nearly 50% of U.S. patients wait at least six months to undergo TAVR, they wrote, which makes that statistic especially noteworthy.
“Although our study did not address mechanisms or causes of delay in care, existing research suggests these delays may result from referral patterns, recognition of disease, patient preferences, as well as structural issues in the health care system,” the authors wrote. “Limited access to TAVR, specifically, is mediated by multiple factors including hospital size, location, and ownership status.”
Click here to read the full study in Structural Heart, a journal from the Cardiovascular Research Foundation.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.