Key result
Transcatheter aortic valve replacement was associated with higher profits but also higher costs compared to surgical aortic valve replacement, resulting in a significantly lower profitability (9.3% vs 11.7%).
Why the study?
Indications for TAVR have expanded to intermediate surgical risk patients, but the profitability of TAVR compared with conventional surgery had not been evaluated.
Does transcatheter aortic valve replacement improve profitability compared to surgical aortic valve replacement in patients eligible for valve replacement?
Cohort (n=579)
No
Does transcatheter aortic valve replacement improve profitability compared to surgical aortic valve replacement in patients eligible for valve replacement?
Absolute Event Rate: 9.3% vs 11.7%
p-value: p=<0.001
TAVR generates higher absolute profits but lower overall profitability compared to SAVR due to significantly higher procedural costs, primarily driven by the price of the bioprosthesis.
BACKGROUND: Current scientific guidelines have extended the indication for transcatheter aortic valve replacement (TAVR) to patients who present an intermediate risk for surgery and have been so far considered for conventional surgery. We previously demonstrated that the TAVR procedure generated profits despite elevated costs, but comparison with surgery has not been performed. The objective of this study was to assess the profitability of the TAVR procedure compared with conventional surgery in a high-volume French hospital. Consecutive patients eligible for transfemoral TAVR or surgical aortic valve replacement (SAVR) were included retrospectively in this single-centre study between September 2014 and December 2015. The primary endpoint was the profitability of each procedure (defined as the ratio between the profit and total revenues), calculated for each patient. Secondary composite endpoints included major adverse events in the 30 days following procedure and breakdown of costs. RESULTS: Two hundred and thirty-eight patients were included in the TAVR group and 341 in the SAVR group. TAVR patients presented higher operative risk scores and more comorbidities. Compared with SAVR, TAVR was associated with higher profits (€2732 ± 1768 per patient vs. €2177 ± 2437 per patient, P < 0.001) but also higher costs (€27,778 ± 4961 vs. €17,813 ± 6071, P < 0.001) resulting in lower profitability (9.3 ± 5.7% vs. 11.7 ± 10.1%, P < 0.001). The price of the bioprosthesis represented 70% of the TAVR total cost. CONCLUSIONS: TAVR performed in carefully selected patients was associated with higher profits than SAVR, but also higher costs resulting in lower profitability.
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Huchet et al. (2019) conducted a cohort in Severe aortic valve stenosis (n=579). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Profitability (ratio between profit and total revenues) (p=<0.001). Transcatheter aortic valve replacement was associated with higher profits but also higher costs compared to surgical aortic valve replacement, resulting in a significantly lower profitability (9.3% vs 11.7%).
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