[The cost of innovation in treating aortic stenosis: transcatheter aortic valve implantation].
BACKGROUND
Transcatheter aortic valve implantation (TAVI) represents a promising therapeutic option for patients affected by severe aortic stenosis, but it is currently associated with high costs. Therefore, the assessment of its economic impact becomes urgent to support decision-makers' choices about its use, patient access to treatment and reimbursement mechanisms.


METHODS
A retrospective, observational, single-center (the teaching hospital located in Bologna, Italy) study was conducted. All patients with severe symptomatic aortic stenosis undergoing TAVI during the enrolment period (February 2008-August 2010) were included. The procedures were performed with both bioprostheses approved for clinical use and through different vascular access: CoreValve transfemoral (CV-TF), CoreValve transsubclavian (CV-TS), Edwards Sapien transapical (ES-TA), Edwards Sapien transfemoral (ES-TF). Costs of the whole index hospitalization have been calculated from the hospital perspective. Healthcare resource consumption was measured at patient level and assessed using unit costs (micro-costing approach).


RESULTS
Overall, 87 consecutive patients (48 CV-TF, 12 CV-TS, 20 ES-TA, 7 ES-TF) were included in the study. They presented a high-risk profile (age 83.3 ± 5.4 years; logistic EuroSCORE 23.3 ± 12.3%) and important comorbidity. In-hospital mortality was 3.4%. Total cost of hospitalization was, on average, €35.841 (range €27.267-69.744) of which 68% was attributable to the procedure. A huge variation in costs was observed among different treatment groups. Patients treated with transfemoral implant (CV-TF: €33.977; ES-TF: €31.442) were on average less expensive than others (CV-TS: €37.035; ES-TA: €41.139).


CONCLUSIONS
Our findings show that treating patients with TAVI places a heavy burden on hospital budget. Hence, due to the shortage of financial resources, affordability of TAVI requires further attention.
Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna. SBartoli@Regione.Emilia-Romagna.it
Simona
S
Bartoli
Francesco
F
Saia
Cinzia
C
Marrozzini
Elena
E
Berti
Paolo
P
Guastaroba
Daniela
D
Fortuna
Cristina
C
Ciuca
Carolina
C
Moretti
Antonio
A
Marzocchi
Rossana
R
De Palma
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000379:methods; D001024:Aortic Valve Stenosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D001705:Bioprosthesis / Q000191:economics; D002406:Catheterization, Peripheral / Q000191:economics* / Q000379:methods; D015897:Comorbidity; D005260:Female; D005263:Femoral Artery; D019918:Heart Valve Prosthesis Implantation / Q000191:economics* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D017721:Hospital Costs; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics*; D008297:Male; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013348:Subclavian Artery; D016896:Treatment Outcome