title: Cost of transcatheter aortic valve implantation and factors associated with higher hospital stay cost in patients of the FRANCE (FRench Aortic National CoreValve and Edwards) registry.
abstract: BACKGROUND
  Currently, several anatomical approaches and intervention sites can be used to perform transcatheter aortic valve implantations (TAVIs), often with no clinical indications for choosing one or another. While these choices can have an impact on resource consumption, no costing study is available in the European context to provide information on resource use and assist decision-making.
  
  
  OBJECTIVE
  To provide comparative data on the cost of the TAVI procedure, depending on anatomical approach and intervention site used, from a hospital perspective, and to analyze factors associated with cost of hospital stay.
  
  
  METHODS
  Multicentre national registry data were collected in 16 centres between January and October 2009. For 287 patients, a descriptive costing study and a multivariable analysis of hospital stay cost were performed.
  
  
  RESULTS
  The mean cost of the TAVI procedure was €22,876 and the mean initial hospital stay cost was €35,164. The procedure cost, excluding valve cost, did not differ between anatomical approaches and was highest in the hybrid room and lowest in the catheterization laboratory. Factors associated with higher hospital stay cost were transapical approach, Society of Thoracic Surgeons score>10%, warfarin use at inclusion, complications during procedure and pacemaker implantation following valve implantation.
  
  
  CONCLUSIONS
  If clinical considerations do not interfere, hospital staff may find it economically favorable to opt for the catheterization laboratory and against the hybrid room. The mean hospital stay cost is higher than the tariff paid in 2011, a difference that has grown since the change in tariff in 2012, representing an economic disincentive for the uptake of TAVI in France.
authors.affiliation: URC Eco, AP-HP, Hôtel-Dieu, Paris, France. karine.chevreul@urc-eco.fr
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
authors.forename: Matthias
authors.initials: M
authors.lastname: Brunn
authors.forename: Benjamin
authors.initials: B
authors.lastname: Cadier
authors.forename: Georges
authors.initials: G
authors.lastname: Haour
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.forename: Gérard
authors.initials: G
authors.lastname: Fournial
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Debrux
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.forename: Pascal
authors.initials: P
authors.lastname: Gueret
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D002304:Cardiac Pacing, Artificial / Q000191:economics; D017046:Cost Savings; D016527:Drug Costs; D005260:Female; D005602:France; D006350:Heart Valve Prosthesis / Q000191:economics; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D016014:Linear Models; D008297:Male; D018803:Models, Economic; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000191:economics; D010561:Personnel Staffing and Scheduling / Q000191:economics; D011474:Prosthesis Design; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin