National indication document and aortic valve replacement landscape in the Netherlands

Abstract

Introduction: Based on European guidelines, transcatheter aortic valve implementation (TAVI) could be the therapy of choice in patients with severe aortic stenosis aged ≥ 75 years. In the Netherlands, there has been a debate between healthcare providers and the National Health Care Institute regarding reimbursement for TAVI, which resulted in an indication document that defines TAVI patients who are eligible for reimbursement. This document has been effective since 1 January 2021.

Methods: We extracted data from the Netherlands Heart Registry for patients who underwent biological surgical aortic valve replacement (SAVR) or TAVI in the Netherlands from 2018 through 2021. We compared baseline characteristics and variables from the indication document for the subsequent years and age groups. We also analysed the annual SAVR/TAVI ratio.

Results: The total number of patients treated with SAVR or TAVI was constant in 2018-2021. Baseline characteristics of patients treated with TAVI did not differ throughout the years. The SAVR/TAVI ratio shifted towards a higher percentage of TAVI from 2018 to 2019. From 2019 to 2020, the TAVI percentage was constant. Since the implementation of the indication document (in 2021), a change in the SAVR/TAVI ratio was not found either.

Conclusion: Since the implementation of the national indication document for AVR in 2021, no major effect was seen for the SAVR versus TAVI landscape in the Netherlands.

Keywords: Indication document; NHR; SAVR; TAVI.

Fig. 1

Ratio of surgical aortic valve replacement (SAVR) versus transcatheter aortic valve implementation (TAVI) per heart centre in 2021, with total number of procedures for SAVR and TAVI

Fig. 2

Number of transcatheter aortic valve implementation (TAVI) and surgical aortic valve replacement (SAVR) procedures in 2018–2021

Fig. 3

Most chosen variables of indication document resulting in TAVI. (TAVI transcatheter aortic valve implementation, NA not applicable, LVEF left ventricular ejection fraction, GFR glomerular filtration rate, COPD chronic obstructive pulmonary disease, CVA cerebrovascular accident, TIA transient ischaemic attack, BMI body mass index, PHT pulmonary hypertension)