Key result
TAVR linked to ~$32,000 to $41,000 lower 1-year costs vs. SAVR across lower frailty strata.
Why the study?
Although 1-year costs are lower with TAVR than SAVR among Medicare beneficiaries with aortic stenosis, the cost difference in commercially insured US patients was unknown.
Does transcatheter aortic valve replacement (TAVR) reduce total 1-year healthcare costs compared to surgical aortic valve replacement (SAVR) in commercially insured patients with severe aortic stenosis?
Cohort (n=3,623)
Yes
Does transcatheter aortic valve replacement (TAVR) reduce total 1-year healthcare costs compared to surgical aortic valve replacement (SAVR) in commercially insured patients with severe aortic stenosis?
In commercially insured patients with severe aortic stenosis, TAVR is associated with lower index hospitalization costs across all frailty strata and lower overall 1-year costs in low and intermediate frailty patients compared to SAVR, though 1-year cost differences are attenuated when restricted to isolated AVR.
Background Patients with aortic stenosis (AS) have been shown to have lower costs at 1 year with transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in a Medicare population. The difference in costs between TAVR and SAVR in commercially insured patients with AS in the United States is unknown.Methods Using the Optum claims database, AS patients receiving either TAVR or SAVR between 3/2019 and 9/2022 were identified. Patients were categorized into low, intermediate or high strata using the Hospital Frailty Risk Score (HFRS). The primary outcome was total 1-year cost, defined as the sum of index AVR hospitalization and 1-year follow-up costs. Risk-adjusted generalized linear models were used to assess the difference in the costs between TAVR and SAVR.Results 3,623 patients (952 TAVR; 2,671 SAVR) were identified. TAVR patients had lower index hospitalization costs compared with SAVR patients across all HFRS strata (cost difference for low: $39,312, p < 0.01; intermediate: $42,006, p < 0.01; high: $39,431, p = 0.03). Cumulative costs through one year were significantly lower with TAVR in the low and intermediate HFRS strata (cost difference for low: $32,116, p < 0.01; intermediate $40,905, p < 0.01) and numerically lower in the high HFRS stratum (cost difference: $35,881, p = 0.15). When the analysis was restricted to isolated AVR, the 1-year difference was no longer significant in the low and intermediate HFRS strata ($8,064 and $11,314, respectively) and was numerically reversed in the high HFRS stratum (−$28,804).Conclusions In a commercial payor population of real-world patients with AS, TAVR was associated with lower standardized index hospitalization costs across all HFRS strata and lower standardized 1-year costs in the low and intermediate HFRS strata. These findings demonstrate that baseline frailty and procedural scope are critical determinants of short and intermediate-term cost differences between TAVR and SAVR for the treatment of AS in commercial populations.
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Baron et al. (2026) conducted a cohort in Severe aortic stenosis (n=3,623). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Total 1-year cost (sum of index AVR hospitalization and 1-year follow-up costs) (Cost difference by frailty strata: Low -$32,116; Intermediate -$40,905; High -$35,881, p=<0.01 (low and intermediate); 0.15 (high)). TAVR had significantly lower 1-year total costs than SAVR in commercially insured patients with low ($32,116 less, p<0.01) and intermediate ($40,905 less, p<0.01) frailty risk.
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