[Transcatheter aortic valve implantation versus aortic valve replacement: cost analysis from the regional health service and hospital perspectives].
The aim of this study was to estimate the cost of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) procedures, together with the cost of the first-year hospitalizations following the index ones, in 4 Italian regions where diffusion level of TAVI and coverage decisions are different.



The cost analysis was performed evaluating 372 patients enrolled consecutively from December 1, 2012 to September 30, 2015. The index hospitalization cost was calculated both from the hospital perspective through a full-costing approach and from the regional healthcare service perspective by applying the regional reimbursement tariffs. The follow-up costs were calculated for one year after the index hospitalization, from the regional healthcare sservice perspective, through the identification of hospital admissions for cardiovascular pathologies after the index hospitalization and computation of the relative regional tariffs.



The mean hospitalization cost was € 32 120 for transfemoral TAVI (232 procedures), € 35 958 for transapical TAVI (31 procedures) and € 17 441 for AVR (109 procedures). From the regional healthcare service perspective, the mean transfemoral TAVI cost was € 29 989, with relevant regional variability (range from € 19 987 to € 36 979); the mean transapical TAVI cost was € 39 148; the mean AVR cost was € 32 020. The mean follow-up costs were € 2294 for transfemoral TAVI, € 2335 for transapical TAVI, and € 2601 for AVR.



In our study, transapical TAVI resulted more expensive than transfemoral TAVI, while surgical AVR was cheaper than both (less than 40%). Costs of the transfemoral approach showed great variability between participating regions, probably due to different hospital costs, logistics, patients' selection and reimbursement policy. A central level of control would be appropriate to avoid unjustified differences in access to innovative procedures between different Italian regions.
Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna, Bologna.
Elena
E
Berti
Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna, Bologna.
Daniela
D
Fortuna
Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna, Bologna.
Simona
S
Bartoli
U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna.
Cristina
C
Ciuca
Programmazione delle Attività Sanitarie nelle Aree Patologiche Cardio-Cerebrovascolari, Assessorato alla Sanità, Regione Piemonte, Torino.
Anna
A
Orlando
Dipartimento Attività Sanitarie e Osservatorio Epidemiologico, Assessorato alla Sanità, Regione Sicilia, Palermo.
Salvatore
S
Scondotto
Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, Roma.
Nera
N
Agabiti
Azienda Ospedaliero-Universitaria Città della Salute e della Scienza - San Giovanni Battista, Torino.
Stefano
S
Salizzoni
U.O. Cardiologia, Ospedale Mauriziano Umberto I, Torino.
Tiziana Claudia
TC
Aranzulla
U.O. Cardiologia, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo.
Caterina
C
Gandolfo
Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna, Bologna.
Rossana
R
De Palma
U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna.
Francesco
F
Saia
D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000191:economics; D006761:Hospitals; D006801:Humans; D007558:Italy; D008297:Male; D065467:Transcatheter Aortic Valve Replacement / Q000191:economics*