title: Learning effect and diffusion of innovative medical devices: the case of transcatheter aortic valve implantation in Italy.
abstract: OBJECTIVE
  We investigated the diffusion of transcatheter aortic valve implantation (TAVI) since its introduction into the Italian market aimed at identifying the potential drivers of uptake and diffusion at hospital and regional levels.
  
  
  METHODS
  We estimated the determinants of TAVI diffusion in Italy from 2007 to 2015 with a regression analysis based on registry data.
  
  
  RESULTS
  Since 2007, TAVI has shown significant diffusion rates in Italy. The diffusion is positively correlated with implanting centers' experience and with the presence of key opinion leaders. Regional recommendations on the use of TAVI negatively influence the diffusion. Reimbursement policies do not exert a relevant impact.
  
  
  CONCLUSIONS
  Learning effect seems to be the major driver of TAVI diffusion in Italy.
authors.affiliation: Center for Research on Health & Social Care Management (CERGAS), Università Bocconi, Milan, Italy.
authors.forename: Giuditta
authors.initials: G
authors.lastname: Callea
authors.affiliation: Center for Research on Health & Social Care Management (CERGAS), Università Bocconi, Milan, Italy.
authors.forename: Maria Caterina
authors.initials: MC
authors.lastname: Cavallo
authors.affiliation: Center for Research on Health & Social Care Management (CERGAS), Università Bocconi, Milan, Italy.|Department for Institutional Analysis & Public Sector Management, Università Bocconi, Milan, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Tarricone
authors.affiliation: Center for Research on Health & Social Care Management (CERGAS), Università Bocconi, Milan, Italy.|Department for Institutional Analysis & Public Sector Management, Università Bocconi, Milan, Italy.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Torbica
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D057186:Comparative Effectiveness Research / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D012042:Registries / Q000706:statistics & numerical data; D065467:Transcatheter Aortic Valve Replacement / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: aortic stenosis; diagnosis-related groups; diffusion; learning effect; reimbursement; transcatheter aortic valve implantation