Cost and contribution margin of transcatheter versus surgical aortic valve replacement. J Thorac Cardiovasc Surg 2017 Dec;154(6):1872-1880.e1
Date
07/18/2017Pubmed ID
28712581Pubmed Central ID
PMC6528835DOI
10.1016/j.jtcvs.2017.06.020Scopus ID
2-s2.0-85023641246 (requires institutional sign-in at Scopus site) 32 CitationsAbstract
OBJECTIVE: To compare the cost of and payments for transcatheter aortic valve replacement (TAVR), a novel and expensive technology, and surgical aortic valve replacement (SAVR).
METHODS: Medicare claims provided hospital charges, payments, and outcomes between January and December 2012. Hospital costs and charges were estimated using hospital-specific cost-to-charge ratios. Costs and payments were examined in propensity score- matched TAVR and SAVR patients.
RESULTS: Medicare spent $215,770,200 nationally on 4083 patients who underwent TAVR in 2012. Hospital costs were higher for TAVR patients (median, $50,200; interquartile range [IQR], $39,800-$64,300) than for propensity-matched SAVR patients ($45,500; IQR, $34,500-$63,300; P < .01), owing largely to higher estimated medical supply costs, including the implanted valve prosthesis. Postprocedure hospital length of stay (LOS) length was shorter for TAVR patients (median, 5 days [IQR, 4-8 days] vs 7 days [IQR, 5-9 days]; P < .01), as was total intensive care unit (ICU) LOS (median, 2 days [IQR, 0-5 days] vs 3 days [IQR, 1-6 days]; P < .01). Medicare payments were lower for TAVR hospitalizations (median, $49,500; IQR, $36,900-$64,600) than for SAVR (median, $50,400; IQR, $37,400-$65,800; P < .01). The median of the differences between payments and costs (contribution margin) was -$3380 for TAVR hospitalizations and $2390 for SAVR hospitalizations (P < .01).
CONCLUSIONS: TAVR accounted for $215 million in Medicare payments in its first year of clinical use. Among SAVR Medicare patients at a similar risk level, TAVR was associated with higher hospital costs despite shorter ICU LOS and hospital LOS. Overall and/or medical device cost reductions are needed for TAVR to have a net neutral financial impact on hospitals.
Author List
McCarthy FH, Savino DC, Brown CR, Bavaria JE, Kini V, Spragan DD, Dibble TR, Herrmann HC, Anwaruddin S, Giri J, Szeto WY, Groeneveld PW, Desai NDAuthor
Saif Anwaruddin MD Associate Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Administrative Claims, HealthcareAged
Aged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Cost-Benefit Analysis
Databases, Factual
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Hospital Charges
Hospital Costs
Humans
Insurance, Health, Reimbursement
Length of Stay
Male
Medicare
Propensity Score
Time Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
United States
