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Int J Cardiol. 2015 Jan 20;179:231-7. doi: 10.1016/j.ijcard.2014.11.095. Epub 2014 Nov 11.

Analysis of the additional costs of clinical complications in patients undergoing transcatheter aortic valve replacement in the German Health Care System.

Author information

1
Department of Cardiology and Angiology I, Heart Center Freiburg University, Germany.
2
Department of Cardiology and Angiology I, Heart Center Freiburg University, Germany; Center for Medical Biometry and Medical Informatics, Medical Center, University of Freiburg, Germany. Electronic address: kaier@imbi.uni-freiburg.de.
3
Department of Cardiovascular Surgery, Heart Center Freiburg University, Germany.
4
Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Germany.
5
Center for Medical Biometry and Medical Informatics, Medical Center, University of Freiburg, Germany.

Abstract

BACKGROUND:

This study aims at analyzing complication-induced additional costs of patients undergoing transcatheter aortic valve replacement (TAVR).

METHODS:

In a prospective observational study, a total of 163 consecutive patients received either transfemoral (TF-, n=97) or transapical (TA-) TAVR (n=66) between February 2009 and December 2012. Clinical endpoints were categorized according to VARC-2 definitions and in-hospital costs were determined from the hospital perspective. Finally, the additional costs of complications were estimated using multiple linear regression models.

RESULTS:

TF-TAVR patients experienced significantly more minor access site bleeding, major non-access site bleeding, minor vascular complications, stage 2 acute kidney injury (AKI) and permanent pacemaker implantation. Total in-hospital costs did not differ between groups and were on average €40,348 (SD 15,851) per patient. The average incremental cost component of a single complication was €3438 (p<0.01) and the estimated cost of a TF-TAVR without complications was €34,351. The complications associated with the highest additional costs were life-threatening non-access site bleeding (€47,494; p<0.05), stage 3 AKI (€20,468; p<0.01), implantation of a second valve (€16,767; p<0.01) and other severe cardiac dysrhythmia (€10,611 p<0.05). Overall, the presence of complication-related in-hospital mortality increased costs.

CONCLUSIONS:

Bleeding complications, severe kidney failure, and implantation of a second valve were the most important cost drivers in our TAVR patients. Strategies and advances in device design aimed at reducing these complications have the potential to generate significant in-hospital cost reductions for the German Health Care System.

KEYWORDS:

Cost analysis; Resource utilization; TAVI; TAVR; VARC complication

PMID:
25464455
DOI:
10.1016/j.ijcard.2014.11.095
[Indexed for MEDLINE]

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