Relative Costs of Surgical and Transcatheter Aortic Valve Replacement and Medical Therapy

Andrew M. Goldsweig, Hyo Jung Tak, Li Wu Chen, Herbert D. Aronow, Binita Shah, Dhaval Kolte, Nihar R. Desai, Molly Szerlip, Poonam Velagapudi, J. Dawn Abbott

Research output: Contribution to journalArticle

Abstract

Background: The number of patients treated for aortic valve disease in the United States is increasing rapidly. Transcatheter aortic valve replacement (TAVR) is supplanting surgical aortic valve replacement (SAVR) and medical therapy (MT). The economic implications of these trends are unknown. Therefore, we undertook to determine the costs, inpatient days, and number of admissions associated with treating aortic valve disease with SAVR, TAVR, or MT. Methods: Using the Nationwide Readmissions Database, we identified patients with aortic valve disease admitted 2012 to 2016 for SAVR, TAVR, and disease symptoms (congestive heart failure, unstable angina, non-ST-elevation myocardial infarction, syncope). Patients not undergoing SAVR or TAVR were classified as receiving MT. Beginning with the index admission, we estimated inpatient costs, days, and admissions over 6 months. Results: Among 190 563 patients with aortic valve disease, the average aggregate 6-month inpatient costs were $59 743 for SAVR, $64 395 for TAVR, and $23 460 for MT. Mean index admission was longer for SAVR (10.0 days) than for TAVR (7.0 day) or MT (5.3 days), but the average number of unplanned readmission inpatient days was 2.0 for SAVR, 3.0 for TAVR, and 4.3 for MT; the average number of total admissions was 1.3 for SAVR, 1.5 for TAVR, and 1.7 for MT (P<0.01 for all). TAVR index admission costs decreased over time to become similar to SAVR costs by 2016. Conclusions: Aggregate costs were higher for TAVR than SAVR and were significantly more expensive than MT alone. However, TAVR costs decreased over time while SAVR and MT costs remained unchanged.

Original languageEnglish (US)
JournalCirculation: Cardiovascular Interventions
DOIs
StatePublished - May 1 2020

Keywords

  • aortic valve
  • heart failure
  • myocardial infarction
  • syncope
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Goldsweig, A. M., Tak, H. J., Chen, L. W., Aronow, H. D., Shah, B., Kolte, D., Desai, N. R., Szerlip, M., Velagapudi, P., & Abbott, J. D. (2020). Relative Costs of Surgical and Transcatheter Aortic Valve Replacement and Medical Therapy. Circulation: Cardiovascular Interventions. https://doi.org/10.1161/CIRCINTERVENTIONS.119.008681