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Comparative Study
. 2017 Dec;154(6):1872-1880.e1.
doi: 10.1016/j.jtcvs.2017.06.020. Epub 2017 Jun 21.

Cost and contribution margin of transcatheter versus surgical aortic valve replacement

Fenton H McCarthy  1 , Danielle C Savino  2 , Chase R Brown  2 , Joseph E Bavaria  2 , Vinay Kini  3 , Danielle D Spragan  2 , Taylor R Dibble  2 , Howard C Herrmann  4 , Saif Anwaruddin  4 , Jay Giri  4 , Wilson Y Szeto  2 , Peter W Groeneveld  5 , Nimesh D Desai  6
Affiliations
Comparative Study

Cost and contribution margin of transcatheter versus surgical aortic valve replacement

Fenton H McCarthy et al. J Thorac Cardiovasc Surg. 2017 Dec.

Abstract

Objective: To compare the cost of and payments for transcatheter aortic valve replacement (TAVR), a novel and expensive technology, and surgical aortic valve replacement (SAVR).

Methods: Medicare claims provided hospital charges, payments, and outcomes between January and December 2012. Hospital costs and charges were estimated using hospital-specific cost-to-charge ratios. Costs and payments were examined in propensity score- matched TAVR and SAVR patients.

Results: Medicare spent $215,770,200 nationally on 4083 patients who underwent TAVR in 2012. Hospital costs were higher for TAVR patients (median, $50,200; interquartile range [IQR], $39,800-$64,300) than for propensity-matched SAVR patients ($45,500; IQR, $34,500-$63,300; P < .01), owing largely to higher estimated medical supply costs, including the implanted valve prosthesis. Postprocedure hospital length of stay (LOS) length was shorter for TAVR patients (median, 5 days [IQR, 4-8 days] vs 7 days [IQR, 5-9 days]; P < .01), as was total intensive care unit (ICU) LOS (median, 2 days [IQR, 0-5 days] vs 3 days [IQR, 1-6 days]; P < .01). Medicare payments were lower for TAVR hospitalizations (median, $49,500; IQR, $36,900-$64,600) than for SAVR (median, $50,400; IQR, $37,400-$65,800; P < .01). The median of the differences between payments and costs (contribution margin) was -$3380 for TAVR hospitalizations and $2390 for SAVR hospitalizations (P < .01).

Conclusions: TAVR accounted for $215 million in Medicare payments in its first year of clinical use. Among SAVR Medicare patients at a similar risk level, TAVR was associated with higher hospital costs despite shorter ICU LOS and hospital LOS. Overall and/or medical device cost reductions are needed for TAVR to have a net neutral financial impact on hospitals.

Keywords: AVR; SAVR; TAVR; cost.

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Conflict of interest statement

Conflict of Interest Statement

All other authors have nothing to disclose with regard to commercial support.

Figures

FIGURE 1.
FIGURE 1.
Annual CMS payments for TAVR and isolated SAVR in 2011 and 2012. CMS, Center for Medicare and Medicaid Services; TAVR, transcatheter aortic valve replacement; SAVR, surgical aortic valve replacement; IQR, interquartile range.
FIGURE 2.
FIGURE 2.
A, Median ICU costs for propensity-matched SAVR and TAVR patients. The lower quartile, median, and upper quartile represent the boxplot, and the minimum and maximum values are shown through the whisker extension on either side of the boxplot, indicating the variation in cost for TAVR and SAVR patients. B, Median resource-associated costs for propensity-matched SAVR and TAVR patients. The lower quartile, median, and upper quartile represent the boxplot, and the minimum and maximum values are shown through the whisker extension on either side of the boxplot, indicating the variation in cost for propensity-matched TAVR and SAVR patients. SAVR, Surgical aortic valve replacement; TAVR, transcatheter aortic valve replacement.
FIGURE 3.
FIGURE 3.
TAVR contribution margin per patient by institutional TAVR volume. TAVR, Transcatheter aortic valve replacement.
See this image and copyright information in PMC

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References

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