Hospitalization costs in the United States for transcatheter aortic valve replacement (TAVR) procedures are highly inconsistent, according to new findings published in The Annals of Thoracic Surgery.[1]
“TAVR represents a rapidly emerging technology that has been previously associated with annual costs in excess of $2.8 billion in the United States,” wrote fist author Yas Sanaiha, MD, of the Cardiac Outcomes Research Laboratory at the University of California, Los Angeles, and colleagues. “While TAVR has revolutionized the care of patients at high risk for surgical intervention, it has traditionally been deployed in those with limited life expectancy. As such, insurance providers have established quality-of-life metrics beyond mortality in order to restrict the application of TAVR to candidates who will derive significant benefit. Nonetheless, TAVR has extended the use of aortic valve replacement to patients that would have previously not received surgical intervention, further increasing overall costs. Thus, examination of TAVR costs and efforts to mitigate variations in practice remain particularly relevant.”
Sanaiha et al. explored data from more than 119,000 patients who underwent TAVR from 2016 to 2018. All data came from the Nationwide Readmissions Database. Patients were excluded if their hospitalization resulted in less than $26,000 in healthcare expenditures, because that is the approximate cost of the actual TAVR valve.
The mean patient age was 80 years old, and 45.9% were women. More than one-half of patients presented with congestive heart failure, coronary artery disease and hypertension. Renal, cardiac or respiratory complications occurred in 13.1% of patients. Also, 91.3% of patients were Medicare beneficiaries.
Overall, the mean index hospitalization cost for a TAVR procedure was $50,100, and the median index hospitalization cost was $45,600. There was a considerable amount of variability, the authors noted, with hospitalization costs ranging from $26,000 to $700,000.
The mean and median index hospitalization costs did decrease “significantly” as time went on, dropping from $54,000 and $49,100, respectively, in 2016 to $48,300 and $44,800, respectively, in 2018. At hospitals associated with the lowest spending, the median index hospitalization costs ranged from $26,200 to $47,700, and the mean index hospitalization costs ranged from $26,300 to $64,300.
At the hospitals associated with the most spending, on the other hand, the median index hospitalization costs ranged from $352,000 to $688,300, and the mean index hospitalization costs ranged from $351,500 to $718,300.
One key takeaway from the team’s research was that 54.3% of the variation in hospitalization costs is due to the facility where the procedure was performed and not related to the patient in any way. This, coupled with the fact that high variability is present even when there are no complications, “underscores the importance of standardization,” the authors wrote.
Sanaiha and colleagues pointed to the increased use of conscious sedation instead of general anesthesia as just one example of how TAVR providers are starting to find new ways to lower TAVR costs. “Temporary pacing in the immediate postoperative period” was listed as another prominent example.
Another important takeaway was that certain complications—paravalvular leak and pacemaker placement, for example—are associated with high costs. In-depth research into how such complications are managed “is warranted,” the group wrote.
Read the full analysis here.
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.