title: Costs of periprocedural complications in patients treated with transcatheter aortic valve replacement: results from the Placement of Aortic Transcatheter Valve trial.
abstract: BACKGROUND
  In patients with severe aortic stenosis, transcatheter aortic valve replacement (TAVR) improves survival when compared with nonsurgical therapy but with higher in-hospital and lifetime costs. Complications associated with TAVR may decrease with greater experience and improved devices, thereby reducing the overall cost of the procedure. Therefore, we sought to estimate the effect of periprocedural complications on in-hospital costs and length of stay of TAVR.
  
  
  RESULTS
  Using detailed cost data from 406 TAVR patients enrolled in the Placement of Aortic Transcatheter Valve (PARTNER) I trial, we developed multivariable models to estimate the incremental cost and length of stay associated with specific periprocedural complications. Attributable costs and length of stay for each complication were calculated by multiplying the independent cost of each event by its frequency in the treatment group. Mean cost for the initial hospitalization was $79 619±40 570 ($50 891 excluding the valve); 49% of patients had ≥1 complication. Seven complications were independently associated with increased hospital costs, with major bleeding, arrhythmia, and death accounting for the largest attributable cost per patient. Renal failure and the need for repeat TAVR, although less frequent, were also associated with substantial incremental and attributable costs. Overall, complications accounted for $12 475 per patient in initial hospital costs and 2.4 days of hospitalization.
  
  
  CONCLUSIONS
  In the PARTNER trial, periprocedural complications were frequent, costly, and accounted for ≈25% of non-implant-related hospital costs. Avoidance of complications should improve the cost-effectiveness of TAVR for inoperable and high-risk patients, but reductions in the cost of uncomplicated TAVR will also be necessary for optimal efficiency.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.). suz.v.arnold@gmail.com.
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Yang
authors.initials: Y
authors.lastname: Lei
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Reynolds
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Magnuson
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: John L
authors.initials: JL
authors.lastname: Petersen
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Hemal
authors.initials: H
authors.lastname: Gada
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Susheel K
authors.initials: SK
authors.lastname: Kodali
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Mayo Clinic, Rochester, MN (R.M.S.); Cleveland Clinic Foundation, OH (E.M.T., L.G.S.); Swedish Medical Center, Seattle, WA (J.L.P.); Duke University, Durham, NC (P.S.D.); Columbia-Presbyterian Hospital, New York, NY (H.G., S.K.K., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and Baylor Healthcare System, Plano, TX (M.J.M.).
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006350:Heart Valve Prosthesis / Q000191:economics; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D018803:Models, Economic; D015999:Multivariate Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: aortic valve; complications; costs and cost analysis; transcatheter aortic valve replacement