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Yunoki J, Morita S, Hayashi N, Jinnouchi K, Morokuma H, Itoh M, Kamohara K. The comparison of the clinical outcomes and costs between surgical aortic valve replacement and transcatheter aortic valve implantation based on the Japanese Diagnosis Procedure Combination database. Surg Today 2024; 54:240-246. [PMID: 37395799 DOI: 10.1007/s00595-023-02722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE We evaluated the clinical outcomes and costs of surgical aortic valve replacement (SAVR) and transfemoral transcatheter aortic valve implantation (TAVI) for aortic stenosis using the Japanese Diagnosis Procedure Combination (DPC) database. METHODS Using our extraction protocol, we retrospectively analyzed summary tables in the DPC database from 2016 to 2019, which were provided by the Ministry of Health, Labor and Welfare. A total of 27,278 patients were available (SAVR, n = 12,534; TAVI, n = 14,744). RESULTS The TAVI group was older than the SAVR group (SAVR vs. TAVI: 74.6 vs. 84.5 years; P < 0.01), with a lower in-hospital mortality (1.0 vs. 0.6%; P < 0.01) and a shorter hospital stay (26.9 vs. 20.3 days; P < 0.01). TAVI conferred more total medical service reimbursement points than SAVR (493,944 vs. 605,241 points; P < 0.01), especially materials points (147,830 vs. 434,609 points; P < 0.01). Total insurance claims for TAVI were approximately 1 million yen higher than those for SAVR. Regarding the details of costs, only the operation cost was higher, while other costs were lower with TAVI than with SAVR. CONCLUSION Our analysis revealed that both SAVR and TAVI showed acceptable clinical outcomes. TAVI was associated with higher total insurance claims than SAVR. If the material cost of TAVI operations can be reduced, greater cost-effectiveness can be expected.
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Affiliation(s)
- Junji Yunoki
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | | | - Nagi Hayashi
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kouki Jinnouchi
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroyuki Morokuma
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Manabu Itoh
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Keiji Kamohara
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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D'Errigo P, Marcellusi A, Biancari F, Barbanti M, Cerza F, Tarantini G, Ranucci M, Ussia GP, Costa G, Badoni G, Fraccaro C, Meucci F, Baglio G, Seccareccia F, Tamburino C, Rosato S. Financial Burden of Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 203:1-8. [PMID: 37478636 DOI: 10.1016/j.amjcard.2023.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 07/23/2023]
Abstract
Given the increasing population eligible for transcatheter aortic valve implantation (TAVI), resource utilization has become an important focus in this setting. We aimed to estimate the change in the financial burden of TAVI therapy over 2 different periods. A probabilistic Markov model was developed to estimate the cost consequences of increased center experience and the introduction of newer-generation TAVI devices compared with an earlier TAVI period in a cohort of 6,000 patients. The transition probabilities and hospitalization costs were retrieved from the OBSERVANT (Observational Study of Effectiveness of AVR-TAVI procedures for severe Aortic steNosis Treatment) and OBSERVANT II (Observational Study of Effectiveness of TAVI with new generation deVices for severe Aortic stenosis Treatment) studies, including 1,898 patients treated with old-generation devices and 1,417 patients treated with new-generation devices. The propensity score matching resulted in 853 pairs, with well-balanced baseline risk factors. The mean EuroSCORE II (6.6% vs 6.8%, p = 0.76) and the mean age (82.0 vs 82.1 y, p = 0.62) of the early TAVI period and new TAVI period were comparable. The new TAVI period was associated with a significant reduction in rehospitalizations (-30.5% reintervention, -25.2% rehospitalization for major events, and -30.8% rehospitalization for minor events) and a 20% reduction in 1-year mortality. These reductions resulted in significant cost savings over a 1-year period (-€4.1 million in terms of direct costs and -€19.7 million considering the additional cost of the devices). The main cost reduction was estimated for rehospitalization, accounting for 79% of the overall cost reduction (not considering the costs of the devices). In conclusion, the introduction of new-generation TAVI devices, along with increased center experience, led to significant cost savings at 1-year compared with an earlier TAVI period, mainly because of the reduction in rehospitalization costs.
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Affiliation(s)
- Paola D'Errigo
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA-CEIS), Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Francesco Cerza
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | | | - Gabriella Badoni
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Fraccaro
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Fulvia Seccareccia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Corrado Tamburino
- A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Stefano Rosato
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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Heathcote L, Srivastava T, Sarmah A, Kearns B, Sutton A, Candolfi P. A Systematic Review and Statistical Analysis of Factors Influencing the Cost-Effectiveness of Transcatheter Aortic Valve Implantation for Symptomatic Severe Aortic Stenosis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:459-475. [PMID: 37337594 PMCID: PMC10277006 DOI: 10.2147/ceor.s392566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/15/2023] [Indexed: 06/21/2023] Open
Abstract
Objective Transcatheter aortic valve implantation (TAVI) is a disruptive technology recommended for patients with symptomatic severe aortic stenosis (sSAS). Despite being available for over 15 years in Europe, with an extensive volume of clinical and economic evaluations across all surgical risk groups, there is little evidence on the identification of the key drivers of TAVI's cost-effectiveness. This study sought to identify these factors and quantify their role. Methods A systematic literature review was conducted to identify published economic evaluations of TAVI. This was supplemented by health technology assessment reports. The primary outcome was the likelihood of TAVI being found cost-effective. Secondary outcomes of TAVI being dominant, and the incremental health benefits of TAVI were also explored. Results Forty-two studies, reporting 65 unique analyses, were identified. TAVI was found to be cost-effective and dominant in 74% and 20% of analyses, respectively. The latest generation balloon-expandable TAVI device (SAPIEN 3) was more likely to be found cost-effective, as was TAVI use in low-risk populations and when performed via transfemoral access route. There was heterogeneity in the approach taken to economic modelling, which may also influence estimates of cost-effectiveness. Analyses that found TAVI to be dominant always compared it to surgery and usually considered the latest generation balloon-expandable TAVI device. Largest health benefits were observed for the inoperable risk group. Conclusion For patients with sSAS, TAVI is typically a cost-effective treatment option. There are important differences by device generation, risk group and access route. It is crucial to consider these differences when appraising the health economic evidence-base for TAVI.
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Affiliation(s)
- Laura Heathcote
- School for Health and Related Research, the University of Sheffield, Sheffield, UK
| | - Tushar Srivastava
- School for Health and Related Research, the University of Sheffield, Sheffield, UK
| | | | - Ben Kearns
- School for Health and Related Research, the University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School for Health and Related Research, the University of Sheffield, Sheffield, UK
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Sengupta A, Gauvreau K, Bucholz EM, Newburger JW, Del Nido PJ, Nathan M. Contemporary Socioeconomic and Childhood Opportunity Disparities in Congenital Heart Surgery. Circulation 2022; 146:1284-1296. [PMID: 36164982 DOI: 10.1161/circulationaha.122.060030] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND While singular measures of socioeconomic status have been associated with outcomes after surgery for congenital heart disease, the multifaceted pathways through which a child's environment impacts similar outcomes remain incompletely characterized. We sought to evaluate the association between childhood opportunity level and adverse outcomes after congenital heart surgery. METHODS Data from patients undergoing congenital cardiac surgery from January 2011 to January 2020 at a quaternary referral center were retrospectively reviewed. Outcomes of interest included predischarge (early) mortality or transplant, postoperative hospital length-of-stay, inpatient cost of hospitalization, postdischarge (late) mortality or transplant, and late unplanned reintervention. The primary predictor was a US census tract-based, nationally-normed composite metric of contemporary child neighborhood opportunity comprising 29 indicators across 3 domains (education, health and environment, and socioeconomic), categorized as very low, low, moderate, high, and very high. Associations between childhood opportunity level and outcomes were evaluated using logistic regression (early mortality), generalized linear (length-of-stay and cost), Cox proportional hazards (late mortality), or competing risk (late reintervention) models, adjusting for baseline patient-related factors, case complexity, and residual lesion severity. RESULTS Of 6133 patients meeting entry criteria, the median age was 2.0 years (interquartile range, 3.6 months-8.3 years). There were 124 (2.0%) early deaths or transplants, the median postoperative length-of-stay was 7 days (interquartile range, 5-13 days), and the median inpatient cost was $76 000 (interquartile range, $50 000-130 000). No significant association between childhood opportunity level and early mortality or transplant was observed (P=0.21). On multivariable analysis, children with very low and low opportunity had significantly longer length-of-stay and incurred higher costs compared with those with very high opportunity (all P<0.05). Of 6009 transplant-free survivors of hospital discharge, there were 175 (2.9%) late deaths or transplants, and 1008 (16.8%) reinterventions at up to 10.5 years of follow-up. Patients with very low opportunity had a significantly greater adjusted risk of late death or transplant (hazard ratio, 1.7 [95% CI, 1.1-2.6]; P=0.030) and reintervention (subdistribution hazard ratio, 1.9 [95% CI, 1.5-2.3]; P<0.001), versus those with very high opportunity. CONCLUSIONS Childhood opportunity level is independently associated with adverse outcomes after congenital heart surgery. Children from resource-limited settings thus constitute an especially high-risk cohort that warrants closer surveillance and tailored interventions.
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Affiliation(s)
- Aditya Sengupta
- Departments of Cardiac Surgery (A.S., P.J.dN., M.N.), Boston Children's Hospital, MA
| | - Kimberlee Gauvreau
- Departments of Cardiac Surgery (A.S., P.J.dN., M.N.), Boston Children's Hospital, MA.,Department of Biostatistics, Harvard School of Public Health, Boston, MA (K.G.)
| | - Emily M Bucholz
- Cardiology (K.G., E.M.B., J.W.N.), Boston Children's Hospital, MA
| | - Jane W Newburger
- Cardiology (K.G., E.M.B., J.W.N.), Boston Children's Hospital, MA.,Departments of Pediatrics (J.W.N.), Harvard Medical School, Boston, MA
| | - Pedro J Del Nido
- Departments of Cardiac Surgery (A.S., P.J.dN., M.N.), Boston Children's Hospital, MA.,Surgery (P.J.dN., M.N.), Harvard Medical School, Boston, MA
| | - Meena Nathan
- Departments of Cardiac Surgery (A.S., P.J.dN., M.N.), Boston Children's Hospital, MA.,Surgery (P.J.dN., M.N.), Harvard Medical School, Boston, MA
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Gaede L, Blumenstein J, Eckel C, Grothusen C, Tiyerili V, Sötemann D, Nef H, Elsässer A, Achenbach S, Möllmann H. Transcatheter-based aortic valve replacement vs. isolated surgical aortic valve replacement in 2020. Clin Res Cardiol 2022; 111:924-933. [PMID: 35362737 PMCID: PMC8972898 DOI: 10.1007/s00392-022-02006-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/04/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Based on the results of several recent randomized trials, European and American guidelines on valvular heart disease management have substantially expanded the indications for transcatheter aortic valve implantation (TAVI). We present an all-comer data on peri-operative risk profile and in-hospital outcomes from Germany for patients treated by TAVI or isolated surgical aortic valve replacement (iSAVR) in 2020, providing an opportunity to compare study data with data from daily clinical practice. METHODS Data concerning all isolated aortic valve procedures performed in Germany in 2020 were retrieved from the mandatory nationwide quality control program. Expected mortality was calculated with the annually revised German Aortic valve score (AKL-score) based on the data of either catheter-based (AKL-CATH) or isolated surgical (AKL-CHIR) aortic valve replacement in Germany from the previous year (2019). RESULTS In 2020 21,903 TAVI procedures (20,810 transvascular (TV; vs. 2019: 22.973; - 9.4%), 1093 transapical (TA; vs. 2019: 1413; - 22.6%)) and 6144 (vs. 2019 7905; - 22.5%) iSAVR were performed in Germany. Patients who received TAVI showed a significantly higher perioperative risk profile than patients undergoing iSAVR based on older age and more severe co-morbidities. While in-hospital mortality after TAVI (2.3%) was numerically lower than in 2019 (2.5%), this difference was not significant (p = 0.11). In-hospital mortality after iSAVR was identical in 2020 and 2019 (2.8%) and thus higher than after TAVI (p = 0.003), resulting in an observed expected mortality ratio of 1.02 after TAVI and 1.05 after iSAVR. After exclusion of the emergency procedures, in-hospital mortality did not differ significantly between the groups (TAVI 2.2% vs. iSAVR 1.9%, p = 0.26). CONCLUSION Total numbers of both iSAVR and TAVI in Germany were lower in 2020 than in 2019, most likely due to the COVID-19 pandemic. However, the relative number of patients treated by TAVI as compared to iSAVR continues to increase. Despite older age and more severe comorbidities compared to patients undergoing iSAVR the in-hospital mortality after TAVI continued to decrease in 2020 and remains significantly lower than after iSAVR.
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Affiliation(s)
- Luise Gaede
- Medizinische Klinik 2, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Blumenstein
- Klinik Für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
- Klinikum Oldenburg, Carl-Von-Ossietzky-Universität Oldenburg, Oldenburg, Germany
| | - Clemens Eckel
- Klinik Für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
- Klinikum Oldenburg, Carl-Von-Ossietzky-Universität Oldenburg, Oldenburg, Germany
| | - Christina Grothusen
- Klinik Für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Vedat Tiyerili
- Klinik Für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Dagmar Sötemann
- Klinik Für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Holger Nef
- Klinik Für Kardiologie Und Angiologie, Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Albrecht Elsässer
- Klinik Für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Stephan Achenbach
- Medizinische Klinik 2, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Helge Möllmann
- Klinik Für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund, Germany.
- Department of Cardiology, St-Johannes-Hospital Dortmund, Johannesstraße 9-13, 44137, Dortmund, Germany.
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