WASHINGTON, D.C.—Periprocedural complications to transcatheter aortic valve replacement (TAVR) can account for more than $10,000 of costs, an analysis of data from the CoreValve extreme risk cohort demonstrated. The findings were presented Sept. 14 at the Transcatheter Cardiovascular Therapeutics scientific session.
Suzanne Baron, MD, MSc, of Saint Luke’s Mid America Heart Institute in Kansas City, Mo., and colleagues identified 506 patients with severe aortic stenosis who had been enrolled in the extreme risk trial with complete hospital and billing data. They wanted to explore short-term costs for TAVR and the contribution of specific periprocedural complications to costs.
For the study, they defined complications as death, stroke, MI, access site complications, acute kidney injury, arrhythmia, a new, permanent pacemaker and repeat valve. They calculated costs in 2013 dollars.
“This was a relatively sick group of patients,” Baron observed, “with a predicted STS [Society of Thoracic Surgeons] mortality of over 10 percent.”
They found that 71 percent of patients had at least one complication. The most frequent complications were need for a new pacemaker, major bleeding and arrhythmia. The most costly complication was a need for a repeat valve, at more than $116,000, followed by acute kidney injury, at $49,000.
“Certain complications are relatively rare and they don’t contribute substantially to the overall cost,” she pointed out, so to better understand the contribution of each complication they calculated attributable costs.
Arrhythmias and the need for a permanent pacemaker had the greatest attributable cost for the entire study group, followed by bleeding complications. The total attributable cost of complications was $10,745.
Approach affected cost as well. The attributable cost for patients treated with an iliofemoral approach totaled $10,197 and with a nonifiliofemoral approach it was $12,542.
“Periprocedural complications accounted for approximately 25 percent of nonimplant-related hospital costs,” Baron said. “While repeat TAVR, acute kidney injury and major stroke were associated with the greatest incremental cost to the index hospitalization, arrhythmias, permanent pacemaker implantation and bleeding were associated with the greatest attributable cost.”
Reducing periprocedural complications provided the greatest opportunity to improve the economic value of TAVR, she concluded.