Transcatheter aortic valve replacement (TAVR) is typically a more cost-effective treatment option for patients with severe aortic stenosis than surgical aortic valve replacement (SAVR), according to a large new analysis published in Cureus.[1] The study’s authors focused on the improvements in length of stay (LOS) and post-operative complications that can be achieved when heart teams choose TAVR. However, they added, there are still certain instances when SAVR may be a more cost-effective strategy in the long run.
“TAVR was introduced to clinical practice for high-risk patients in 2011 due to its less invasive nature,” wrote first author Jonathan Kermanshahchi, a researcher with California University of Science and Medicine, and colleagues. “The cost of the procedure has changed rapidly, and we sought to understand the cost-effectiveness of TAVR versus SAVR for aortic stenosis patients while considering the LOS, cost effects of varying comorbidities and complications of the procedures.”
Lengths of stay & comorbidities for TAVR and SAVR
Kermanshahchi et al. explored data from 15 different studies performed in North American countries during a 10-year period of time. One of the team’s primary takeaways was that TAVR is consistently associated with a shorter LOS than surgery—and it’s a difference that will likely keep growing as technologies and techniques evolve. One large study did suggest TAVR is associated with a higher risk of unplanned hospital readmissions, but this was a retrospective study of intermediate- and high-risk patients; other comparisons have indicated unplanned readmissions rates are closer among the two treatment options.
Comorbidities can also influence the total costs associated with aortic valve replacement. While some studies the authors reviewed found that cancer and diabetes were associated with lower costs for TAVR than SAVR, others determined cirrhosis and chronic obstructive pulmonary disease were associated with significantly higher costs for TAVR.
Post-valve replacement complications for TAVR and SAVR
The group also spent time exploring the potential impact of different post-operative complications. Strokes and vascular complications are more common after TAVR, for example, while acute myocardial infarction and major bleeding events are more common after SAVR.
Permanent pacemaker implantation (PPMI) was one potential complication the group discussed at length. PPMI is much more likely after TAVR than SAVR. It is also quite expensive—another recent analysis concluded it increases costs by $24,000 per patient—so there could be a scenario where SAVR is seen as being more cost-effective when patients face a higher risk of PPMI.
Another potential complication Kermanshahchi and colleagues focused on was delirium.
“Post-operative delirium is often seen in older patients who undergo an operation/surgery and is one of the most common post-operative complications for older patients,” the authors wrote. “The patient population for those who are most in need of the treatments of both SAVR and TAVR are usually older adults, so it is imperative to look into post-operative delirium’s effect on cost and outcomes.”
The group highlighted one study that found post-operative delirium, which increases a patient’s LOS and overall healthcare costs—was significantly less common among TAVR patients than SAVR patients. This made TAVR the more cost-effective treatment option in those scenarios.
“This review found that TAVR has a lower cost on patients with certain comorbidities in addition to a lower LOS than SAVR,” the authors concluded. “This information can help tailor clinical decisions based on the patient’s unique comorbidity and history in order to provide better outcomes and cost-saving measures to treat aortic valve pathology.”
Click here to read the team's full analysis.
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.