Economics of Minimalist Transcatheter Aortic Valve Replacement: Results From the 3M-TAVR Economic Study. (18th October 2022)

• Record Type: Journal Article
• Authors: Butala, Neel M.; Wood, David A.; Li, Haiyan; Chinnakondepalli, Khaja; Lauck, Sandra B.; Sathananthan, Janarthanan; Cairns, John A.; Magnuson, Elizabeth A.; Barker, Madeleine; Webb, John G.; Welsh, Robert; Cheung, Anson; Ye, Jian; Velianou, James L.; Wijeysundera, Harindra C.; Asgar, Anita; Kodali, Susheel; Thourani, Vinod H.; Cohen, David J.
• Is Part Of: Circulation. Volume 15:Number 10(2022)
• Page Start: e012168
• Publication Date: 2022-10-18
• Subjects: costs and cost analysis -- hospital -- hospitalization -- length of stay -- Medicare -- transcatheter aortic valve replacement; Cardiovascular system -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; 616.105
• DOI: 10.1161/CIRCINTERVENTIONS.122.012168
• Languages: English
• ISSNs: 1941-7640

Abstract

Abstract : Background: The 3M-TAVR trial (3M-Transcatheter Aortic Valve Replacement) demonstrated the feasibility and safety of next-day hospital discharge after transfemoral TAVR with implementation of a minimalist pathway. However, the economic impact of this approach is unknown. Therefore, we evaluated costs for patients undergoing minimalist TAVR compared with conventional TAVR. Methods: We used propensity matching to compare resource utilization and costs (from a US health care system perspective) for patients in the 3M-TAVR trial with those for transfemoral TAVR patients enrolled in the contemporaneous S3i trial (PARTNER SAPIEN-3 Intermediate Risk). Procedural costs were estimated using measured resource utilization for both groups. For the S3i group, all other costs through 30-day follow-up were assessed by linkage with Medicare claims; for 3M, these costs were assessed using regression models derived from S3i cost and resource utilization data. Results: After 1:1 propensity matching, 351 pairs were included in our study (mean age 82, mean Society of Thoracic Surgery risk score 5.3%). There were no differences in death, stroke, or rehospitalization between the 3M-TAVR and S3i groups through 30-day follow-up. Index hospitalization costs were $10 843/patient lower in the 3M-TAVR cohort, driven by reductions in procedure duration, anesthesia costs, and length of stay. Between discharge and 30 days, costs were similar for the 2 groups such that cumulative 30-day costs were $11 305/patient lower in the 3M-TAVR cohort compared with the S3i cohort ($49 425 versus $60 729, 95% CI for difference $9378 to $13 138; P <0.001). Conclusions: Compared with conventional transfemoral TAVR, use of a minimalist pathway in intermediate-risk patients was associated with similar clinical outcomes and substantial in-hospital cost savings, which were sustained through 30 days. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02287662.