Early post-approval experience with transcatheter aortic valve replacement in the USA

Jennifer M. Burg, Nora F. Fino, Frederick (Fred) Tibayan, Victor Rodriguez, Jaishankar Raman, Firas Zahr, Howard Song

Research output: Contribution to journalArticle

Abstract

Background: Transcatheter aortic valve replacement (TaVr) is changing the treatment of aortic stenosis. We compared cost and clinical outcomes of TaVr versus surgical aortic valve repair (saVr) in the real-world setting since USA TaVr approval in 2012. MeThods: The Nationwide inpatient sample (Nis) dataset was analyzed by quarter (June 2012 to december 2014). Patients (>65 years old) undergoing TAVR or SAVR were identifed and risk stratifed based on APR-DRG Mortality risk score. Outcomes were in-Hospital mortality, length of stay (los), discharge location, and Hospitalization cost. resulTs: TaVr cases per quarter increased from 1900 to 5445 over the study period. TaVr patients were older and had more comorbidities (P<0.001). TaVr patients had longer los (8 vs. 7 days; P<0.001), were less likely to discharge to home (67% vs. 73%; P<0.001), had higher inpatient mortality (5.5% vs. 0.69%; P<0.001) and overall Hospital cost ($ 227,985 vs. $ 148,019; P<0.001) than saVr patients. on multivariate analysis TAVR was associated with increased cost (=0.42; P<0.001) and increased mortality (OR=5.228, CI: 3.508-7.791; P<0.001) but not associated with increased LOS (=0.297; P=0.078) or discharge to facility (OR=1.004, CI: 0.833-1.213; P=0.960). In the last two quarters of 2014 there was no difference between TaVr and saVr los, however TaVr cost did not decrease over the study period. CoNClusioNs: TaVr patients represented a sicker population, however los and discharge location outcomes were equivalent to saVr. TAVR remained signifcantly more expensive across all risk groups and cost did not fall over the course of the study.

Original languageEnglish (US)
Pages (from-to)619-625
Number of pages7
JournalJournal of Cardiovascular Surgery
Volume59
Issue number4
DOIs
StatePublished - Aug 1 2018

Fingerprint

Aortic Valve
Surgical Instruments
Length of Stay
Costs and Cost Analysis
Mortality
Inpatients
Transcatheter Aortic Valve Replacement
Hospital Costs
Diagnosis-Related Groups
Aortic Valve Stenosis
Hospital Mortality
Comorbidity
Hospitalization
Multivariate Analysis
Population
Therapeutics

Keywords

  • Aortic valve
  • Costs and cost analysis
  • Endovascular procedures
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Early post-approval experience with transcatheter aortic valve replacement in the USA. / Burg, Jennifer M.; Fino, Nora F.; Tibayan, Frederick (Fred); Rodriguez, Victor; Raman, Jaishankar; Zahr, Firas; Song, Howard.

In: Journal of Cardiovascular Surgery, Vol. 59, No. 4, 01.08.2018, p. 619-625.

Research output: Contribution to journalArticle

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abstract = "Background: Transcatheter aortic valve replacement (TaVr) is changing the treatment of aortic stenosis. We compared cost and clinical outcomes of TaVr versus surgical aortic valve repair (saVr) in the real-world setting since USA TaVr approval in 2012. MeThods: The Nationwide inpatient sample (Nis) dataset was analyzed by quarter (June 2012 to december 2014). Patients (>65 years old) undergoing TAVR or SAVR were identifed and risk stratifed based on APR-DRG Mortality risk score. Outcomes were in-Hospital mortality, length of stay (los), discharge location, and Hospitalization cost. resulTs: TaVr cases per quarter increased from 1900 to 5445 over the study period. TaVr patients were older and had more comorbidities (P<0.001). TaVr patients had longer los (8 vs. 7 days; P<0.001), were less likely to discharge to home (67{\%} vs. 73{\%}; P<0.001), had higher inpatient mortality (5.5{\%} vs. 0.69{\%}; P<0.001) and overall Hospital cost ($ 227,985 vs. $ 148,019; P<0.001) than saVr patients. on multivariate analysis TAVR was associated with increased cost (=0.42; P<0.001) and increased mortality (OR=5.228, CI: 3.508-7.791; P<0.001) but not associated with increased LOS (=0.297; P=0.078) or discharge to facility (OR=1.004, CI: 0.833-1.213; P=0.960). In the last two quarters of 2014 there was no difference between TaVr and saVr los, however TaVr cost did not decrease over the study period. CoNClusioNs: TaVr patients represented a sicker population, however los and discharge location outcomes were equivalent to saVr. TAVR remained signifcantly more expensive across all risk groups and cost did not fall over the course of the study.",
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AU - Burg, Jennifer M.

AU - Fino, Nora F.

AU - Tibayan, Frederick (Fred)

AU - Rodriguez, Victor

AU - Raman, Jaishankar

AU - Zahr, Firas

AU - Song, Howard

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N2 - Background: Transcatheter aortic valve replacement (TaVr) is changing the treatment of aortic stenosis. We compared cost and clinical outcomes of TaVr versus surgical aortic valve repair (saVr) in the real-world setting since USA TaVr approval in 2012. MeThods: The Nationwide inpatient sample (Nis) dataset was analyzed by quarter (June 2012 to december 2014). Patients (>65 years old) undergoing TAVR or SAVR were identifed and risk stratifed based on APR-DRG Mortality risk score. Outcomes were in-Hospital mortality, length of stay (los), discharge location, and Hospitalization cost. resulTs: TaVr cases per quarter increased from 1900 to 5445 over the study period. TaVr patients were older and had more comorbidities (P<0.001). TaVr patients had longer los (8 vs. 7 days; P<0.001), were less likely to discharge to home (67% vs. 73%; P<0.001), had higher inpatient mortality (5.5% vs. 0.69%; P<0.001) and overall Hospital cost ($ 227,985 vs. $ 148,019; P<0.001) than saVr patients. on multivariate analysis TAVR was associated with increased cost (=0.42; P<0.001) and increased mortality (OR=5.228, CI: 3.508-7.791; P<0.001) but not associated with increased LOS (=0.297; P=0.078) or discharge to facility (OR=1.004, CI: 0.833-1.213; P=0.960). In the last two quarters of 2014 there was no difference between TaVr and saVr los, however TaVr cost did not decrease over the study period. CoNClusioNs: TaVr patients represented a sicker population, however los and discharge location outcomes were equivalent to saVr. TAVR remained signifcantly more expensive across all risk groups and cost did not fall over the course of the study.

AB - Background: Transcatheter aortic valve replacement (TaVr) is changing the treatment of aortic stenosis. We compared cost and clinical outcomes of TaVr versus surgical aortic valve repair (saVr) in the real-world setting since USA TaVr approval in 2012. MeThods: The Nationwide inpatient sample (Nis) dataset was analyzed by quarter (June 2012 to december 2014). Patients (>65 years old) undergoing TAVR or SAVR were identifed and risk stratifed based on APR-DRG Mortality risk score. Outcomes were in-Hospital mortality, length of stay (los), discharge location, and Hospitalization cost. resulTs: TaVr cases per quarter increased from 1900 to 5445 over the study period. TaVr patients were older and had more comorbidities (P<0.001). TaVr patients had longer los (8 vs. 7 days; P<0.001), were less likely to discharge to home (67% vs. 73%; P<0.001), had higher inpatient mortality (5.5% vs. 0.69%; P<0.001) and overall Hospital cost ($ 227,985 vs. $ 148,019; P<0.001) than saVr patients. on multivariate analysis TAVR was associated with increased cost (=0.42; P<0.001) and increased mortality (OR=5.228, CI: 3.508-7.791; P<0.001) but not associated with increased LOS (=0.297; P=0.078) or discharge to facility (OR=1.004, CI: 0.833-1.213; P=0.960). In the last two quarters of 2014 there was no difference between TaVr and saVr los, however TaVr cost did not decrease over the study period. CoNClusioNs: TaVr patients represented a sicker population, however los and discharge location outcomes were equivalent to saVr. TAVR remained signifcantly more expensive across all risk groups and cost did not fall over the course of the study.

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