Objectives:
To describe the economics of transcatheter aortic valve replacement (TAVR) in the US, and to compare costs and payments for TAVR with surgical aortic valve replacement (SAVR) in the context of expanding clinical indications for TAVR.
Methods:
Hospital charges and Medicare payments from Medicare claims for patients undergoing SAVR or TAVR between January and December 2012. Medicare payments represent actual payments to hospitals accounting for transfer penalties. Cost-to-charge ratios were used to estimate hospital costs from charges. Costs and payments were examined in propensity score matched TAVR and SAVR patients.
Results:
Medicare spent $215,770,218 nationally for TAVR in 2012, the first year of commercial implantation. Hospital costs were significantly higher for TAVR (median $50,200; interquartile range (IQR) $39,800 - $64,300) than SAVR ($45,500; $34,500 - $63,300; p <0.01) largely due to higher estimated medical supply costs, which includes the implanted valve prosthesis (Table 1, Figure 1). Medicare payments were lower for TAVR ($50,100; $37800 - $65400) than for SAVR hospitalizations ($51,200; $38,300 - $66,700; p<0.01). Median difference between payments and costs was -$3380 for TAVR and $2390 for SAVR hospitalizations (p<0.01). For hospitals to break even on TAVR, overall costs need to decrease by 7% or isolated medical supply costs (primarily related to the TAVR valve) by 22%.
Conclusions:
Among patients of similar risk, TAVR was associated with higher hospital costs despite shorter ICU and hospital stays compared to SAVR. Overall and/or medical device cost reductions are necessary for TAVR to have a net neutral financial impact on hospitals.
Surgeon Awareness of Operating Room Supply Costs