title: Costs and in-hospital outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement in commercial cases using a propensity score matched model.
abstract: The aim of this study was to compare in-hospital cost and outcomes between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). TAVI is an effective treatment option in patients with symptomatic aortic stenosis who are at high risk for traditional SAVR. Several studies using trial data or outside United States registry data have addressed TAVI cost issues, although there is a paucity of cost data involving commercial cases in the United States. Using Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Nationwide Inpatient Sample files, a propensity score-matched analysis of all commercial TAVI and SAVR cases performed in 2011 was conducted. Overall hospital cost and length of stay, as well as procedural complications, were compared between the 2 matched cohorts: 595 TAVI patients were matched to 1,785 SAVR patients in a 1:3 ratio. There was no difference in mean ($181,912 vs $196,298) or median ($152,993 vs $155,974) hospital cost between TAVI and SAVR (p = 0.60). The TAVI group had significantly shorter lengths of hospital stay than the SAVR group (mean 9.76 vs 12.01 days, p <0.001). There was no difference in postprocedural in-hospital death or stroke, but TAVI patients were more likely to have bleeding complications, to have vascular complications, and to require pacemakers. In conclusion, when analyzing in-hospital cost of commercial TAVI and SAVR cases using the Nationwide Inpatient Sample data set, TAVI is an economically satisfactory alternative to SAVR and results in an approximately 2-day shorter length of stay during the index hospitalization.
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York. Electronic address: rmm2002@med.cornell.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Minutello
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: S Chiu
authors.initials: SC
authors.lastname: Wong
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Swaminathan
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Kaple
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Horn
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Arash
authors.initials: A
authors.lastname: Salemi
authors.affiliation: Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, New York.
authors.forename: Xuming
authors.initials: X
authors.lastname: Sun
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Harsimran
authors.initials: H
authors.lastname: Singh
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Bergman
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Luke K
authors.initials: LK
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000639:trends; D008297:Male; D015233:Models, Statistical; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000191:economics / Q000379:methods*; D014481:United States