Contemporary Resource Utilization and Costs among Patients with Medically Managed Severe Aortic Stenosis: Results from a US National Claims Database

Background Patients with severe aortic stenosis (AS) who are managed medically have a poor prognosis. No contemporary studies have examined the costs and resource utilization associated with medical management for severe AS. Methods We used data from the Optum Market Clarity Database, which links electronic health records (EHR) with claims cost and utilization data, to identify patients with documented severe AS between 2016 and 2020 who did not undergo aortic valve replacement (AVR) within one year following diagnosis. To adjust for comorbidities that may have influenced treatment decisions, medically managed patients were matched 1:1 with similar patients who underwent AVR. Outcomes included healthcare resource utilization and costs during the 4-year period following the initial diagnosis of severe AS. Unadjusted Fine and Gray competing risk models were used to estimate resource utilization, and the Bang/Tsiatis method was used to quantify utilization and cost outcomes while accounting for censoring. Results Over the study period, 6,892 patients presented with newly diagnosed severe AS, of which 3334 (48%) were managed medically and 2812 (41%) were able to be propensity matched with patients who underwent AVR. Over 4 years of follow-up, these patients experienced an average of 1.99 hospitalizations—1.33 of which were related to a cardiovascular condition. Total healthcare-related costs (including hospitalizations, outpatient care, and pharmacy services) were $126,638/patient, of which $56,032 were related to inpatient care, $31,603 were related to outpatient care, and $21,160 were for pharmacy services. Conclusions In contemporary practice, despite the availability of effective treatment, many patients with documented severe AS do not undergo AVR within the first year after diagnosis. These patients with severe AS who are managed medically experience high health-care related resource utilization and costs. Further research is needed to identify factors associated with lack of timely valve replacement and to address barriers to care for these patients. Clinical Perspective What is new? This study examines the utilization and cost associated with untreated severe aortic stenosis in a contemporary U.S. cohort. What are the clinical implications? Medically-managed patients with severe aortic stenosis are frail, elderly, with multiple comorbid conditions and have high resource utilization and costs. Further research is needed to identify patients who may benefit from aortic valve replacement.