title: Costs of transcatheter versus surgical aortic valve replacement in intermediate-risk patients.
abstract: BACKGROUND
  Transcatheter aortic valve replacement (TAVR) offers a new treatment option for patients with aortic stenosis, but costs may play a decisive role in decision making. Current studies are evaluating TAVR in an intermediate-risk population. We assessed the in-hospital and 1-year follow-up costs of patients undergoing TAVR and surgical aortic valve replacement (SAVR) at intermediate operative risk and identified important cost components.
  
  
  METHODS
  We prospectively collected clinical data on 141 patients undergoing TAVR and 405 undergoing SAVR. Propensity score matching yielded 42 matched pairs at intermediate risk. Costs were assessed using a detailed resource-use approach and compared using bootstrap methods.
  
  
  RESULTS
  In-hospital costs were higher in TAVR patients than in SAVR patients (€40802 vs €33354, respectively; p=0.010). The total costs at 1 year were €46217 vs €35511, respectively (p=0.009). The TAVR was less costly with regard to blood products, operating room use, and length-of-stay.
  
  
  CONCLUSIONS
  For intermediate-risk patients with severe aortic stenosis the costs at 1 year are higher for TAVR than for SAVR. The difference was mainly caused by the higher costs of the transcatheter valve and was not compensated by the lower costs for blood products and hospital stay in TAVR patients. Therefore, SAVR remains a clinically and economically attractive treatment option.
authors.affiliation: Department of Epidemiology, Cardio-Thoracic Surgery, Radiology, and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Ruben L J
authors.initials: RL
authors.lastname: Osnabrugge
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Head
authors.forename: Tessa S S
authors.initials: TS
authors.lastname: Genders
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
authors.forename: Peter P T
authors.initials: PP
authors.lastname: De Jaegere
authors.forename: Robert M A
authors.initials: RM
authors.lastname: van der Boon
authors.forename: J Marco
authors.initials: JM
authors.lastname: Kerkvliet
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: M G Myriam
authors.initials: MG
authors.lastname: Hunink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000191:economics / Q000601:surgery*; D006328:Cardiac Catheterization / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000191:economics* / Q000379:methods; D006801:Humans; D008297:Male; D009426:Netherlands; D057216:Propensity Score; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index