TAVR Prices Increase as SAVR gets Cheaper

Recent research in JAMA Surgery showed that the adjusted-upfront costs of transcatheter aortic valve replacement (TAVR) are increasing, while the costs of surgical aortic valve replacement (SAVR) are decreasing. 

“Our study demonstrates the impact of newly introduced TAVR technology on resource use in SAVR,” Boback Ziaeian, MD, PhD, of the division of cardiology at the University of California, and colleagues wrote. “The reduction in cost of SAVR and stabilization of disease severity reflect more efficient allocation of resources between SAVR and TAVR. However, the cost of TAVR is increasing.”

The researchers studied a cohort of 173,108 adult patients who underwent isolated aortic valve replacement between 2004 and 2013. Patient data were collected from the National Inpatient Sample’s Healthcare Cost and Utilization Project using ICD-9 codes for SAVR and TAVR. They measured and compared cost, length of stay, and mortality over the study period. The researcher divided the cohort into 3 study groups, patients who underwent SAVR between 2004 and 2010, patients who underwent SAVR between 2011 and 2013, and patients who underwent TAVR between 2011 and 2013.

Study results showed that the average cost of the later SAVR cohort was $3093 higher than the early SAVR cohort; however, average costs for SAVR have decreased by 4.92% since 2011
(P < .001). The researchers noted that costs related to length of stay and complications remained stable after 2011, and mortality decreased over the study period (P < .001).

However, in the TAVR group, costs increased from $51,008 to $55,136 (P < .001). They also found no difference between SAVR and TAVR groups for mortality rates or ostoperative neurologic complications, despite the finding that TAVR was 8.38% more expensive than SAVR. 

The researchers noted that this increase in price for TAVR could warrant legislative intervention as the procedure becomes more widely adopted for lower severity patients.

“Previous analyses have recommended reductions in the initial cost of TAVR to ensure its cost-effectiveness in practice and implicated the higher fixed cost of the valve,” Dr Ziaeian and colleagues concluded. “Our data show that this discrepancy remains despite the development of new generations of valves and increased competition in transcatheter technology. As the indication for TAVR expands to medium- and low-risk cohorts, legislation may be necessary to ensure its cost-effectiveness.” —David Costill