TAVR or SAVR? Market competition may be influencing these decisions
Hospitals located in more competitive markets may be more likely to treat patients with transcatheter aortic valve replacement (TAVR) instead of surgical aortic valve replacement (SAVR), according to new data published in JACC: Advances.[1]
“Importantly, adoption of new technologies may be influenced by a myriad of both medical and nonmedical factors,” wrote senior author Peyman Benharash, MD, a cardiac surgeon with the University of California, Los Angeles, and colleagues. “Economic drivers and hospital market competition, in particular, have been shown to influence surgical management strategy, from robotic surgery to the availability of drug-eluting stents or coronary angioplasty. Availability of such technology may serve to attract patients and could be of financial significance when centers face greater competition from surrounding institutions … With the exponential growth of TAVR, it remains unclear whether market competition may influence contemporary TAVR utilization, particularly among younger patients.”
Benharash et al. tracked data from more than 137,000 patients who underwent TAVR or SAVR from 2018 to 2021. Data came from a variety of inpatient databases. Researchers then used a popular metric, the Herfindahl-Hirschman Index, to determine whether or not the centers performing each procedure were located in a competitive market.
Overall, 61% of the procedures were performed in competitive markets and the other 39% were performed in noncompetitive markets. In competitive markets, 77% of aortic valve replacements were TAVRs and the other 23% were SAVRs. In noncompetitive markets, meanwhile, 76% of aortic valve replacements were TAVRs and the other 24% were SAVRs. In both types of markets, competitive and noncompetitive, TAVR became more common over time.
The authors highlighted the fact that slightly more patients underwent TAVR in hospitals located in competitive markets. After adjusting for certain risks and exploring overall cardiac procedure volume, the group determined that being treated at a competitive hospital was associated with a 68% increase in a patient’s relative risk of receiving TAVR over SAVR. Also, younger patients were more likely to be treated with TAVR in highly competitive hospitals.
Mortality and morbidity rates were comparable for the two market types, the authors emphasized. Per-patient costs, however, were higher at the more competitive hospitals.
“In our study, higher market competition was associated with significantly greater likelihood of receiving TAVR,” the authors wrote. “This finding supports a potentially uncomfortable, but practical, reality: surgeons and hospitals may feel compelled to offer TAVR to meet patient and market demands.”
Benharash and colleagues concluded more research is still necessary to learn more about this subject; many unanswered questions remain. For example, what factors are driving the increased per-patient costs at competitive hospitals? And will market competition make a long-term impact on patient outcomes or quality of life?
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.