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Clinical Trial
. 2022 Oct;15(10):e012168.
doi: 10.1161/CIRCINTERVENTIONS.122.012168. Epub 2022 Oct 18.

Economics of Minimalist Transcatheter Aortic Valve Replacement: Results From the 3M-TAVR Economic Study

Neel M Butala  1 , David A Wood  2 , Haiyan Li  3 , Khaja Chinnakondepalli  3 , Sandra B Lauck  2 , Janarthanan Sathananthan  2 , John A Cairns  2 , Elizabeth A Magnuson  3 , Madeleine Barker  2 , John G Webb  2 , Robert Welsh  4 , Anson Cheung  2 , Jian Ye  2 , James L Velianou  5 , Harindra C Wijeysundera  6 , Anita Asgar  7 , Susheel Kodali  8 , Vinod H Thourani  9 , David J Cohen  10   11 ; 3M-TAVR Investigators
Affiliations
Clinical Trial

Economics of Minimalist Transcatheter Aortic Valve Replacement: Results From the 3M-TAVR Economic Study

Neel M Butala et al. Circ Cardiovasc Interv. 2022 Oct.

Abstract

Background: The 3M-TAVR trial (3M-Transcatheter Aortic Valve Replacement) demonstrated the feasibility and safety of next-day hospital discharge after transfemoral TAVR with implementation of a minimalist pathway. However, the economic impact of this approach is unknown. Therefore, we evaluated costs for patients undergoing minimalist TAVR compared with conventional TAVR.

Methods: We used propensity matching to compare resource utilization and costs (from a US health care system perspective) for patients in the 3M-TAVR trial with those for transfemoral TAVR patients enrolled in the contemporaneous S3i trial (PARTNER SAPIEN-3 Intermediate Risk). Procedural costs were estimated using measured resource utilization for both groups. For the S3i group, all other costs through 30-day follow-up were assessed by linkage with Medicare claims; for 3M, these costs were assessed using regression models derived from S3i cost and resource utilization data.

Results: After 1:1 propensity matching, 351 pairs were included in our study (mean age 82, mean Society of Thoracic Surgery risk score 5.3%). There were no differences in death, stroke, or rehospitalization between the 3M-TAVR and S3i groups through 30-day follow-up. Index hospitalization costs were $10 843/patient lower in the 3M-TAVR cohort, driven by reductions in procedure duration, anesthesia costs, and length of stay. Between discharge and 30 days, costs were similar for the 2 groups such that cumulative 30-day costs were $11 305/patient lower in the 3M-TAVR cohort compared with the S3i cohort ($49 425 versus $60 729, 95% CI for difference $9378 to $13 138; P<0.001).

Conclusions: Compared with conventional transfemoral TAVR, use of a minimalist pathway in intermediate-risk patients was associated with similar clinical outcomes and substantial in-hospital cost savings, which were sustained through 30 days.

Registration: URL: https://www.

Clinicaltrials: gov; Unique identifier: NCT02287662.

Keywords: Medicare; costs and cost analysis; hospital; hospitalization; length of stay; transcatheter aortic valve replacement.

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Figures

Figure.
Figure.
Mean costs and cost differences for the 3M-TAVR (3M-Transcatheter Aortic Valve Replacement) and S3i (PARTNER SAPIEN-3 Intermediate Risk) groups during the index hospitalization, 30-d follow-up period, and total study period. Index hospitalization and follow-up costs were each trimmed at the 99th percentile before summation. 3M-TAVR=green and S3i=blue.
See this image and copyright information in PMC

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