Comparison of Causes and Associated Costs of 30-Day Readmission of Transcatheter Implantation Versus Surgical Aortic Valve Replacement in the United States (A National Readmission Database Study)

• Published in: The American journal of cardiology Vol. 122; no. 3; pp. 431 - 439
• Main Authors: Tripathi, Avnish, Flaherty, Michael P., Abbott, J. Dawn, Fonarow, Gregg C., Khan, Abdur R., Saraswat, Arti, Chahil, Harleen, Kolte, Dhaval, Elmariah, Sammy, Hirsch, Glenn A., Mathew, Verghese, Kirtane, Ajay J., Bhatt, Deepak L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2018; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Aortic valve; Aortic Valve Stenosis - economics; Aortic Valve Stenosis - surgery; Cardiovascular system; Clinical trials; Confidence intervals; Costs; Costs and Cost Analysis; Female; Health care; Heart Valve Prosthesis Implantation - economics; Heart Valve Prosthesis Implantation - methods; Hospital Costs - statistics & numerical data; Hospitals; Humans; Implantation; Male; Medical research; Middle Aged; Patient Readmission - economics; Registries; Regression analysis; Retrospective Studies; Software; Statistical analysis; Surgery; Surgical implants; Time Factors; Transcatheter Aortic Valve Replacement - economics; Transcatheter Aortic Valve Replacement - methods; Transplants & implants; United States; United States; United States > US
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2018.04.024

Our current knowledge about comparative differences in 30-day readmissions and the impact of readmissions on overall costs after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) is largely derived from clinical trials. The objectives of this study were to compare readmissions and costs for TAVI and SAVR in a nationally representative population-based sample. The Healthcare Cost and Utilization Project's National Readmission Database was used for the study. Hierarchical multivariable regression analyses were used to examine differences in the propensity score 1:1 matched cohort. The matched cohort included 4,682 patients who survived index procedures done from January through November 2013. Compared with SAVR, the rate of 30-day readmission was not significantly different for endovascular TAVI (16% vs 18%; p = 0.19); and was higher for the transapical TAVI (22% vs 17%; p <0.01) group. The 30-day cumulative costs were higher for the 2 endovascular TAVI ($51,025 vs $46,228; p = 0.03) and transapical TAVI ($59,575 vs $45,792; p <0.01). In multivariable analyses, the risk of 30-day readmission was similar for endovascular TAVI (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.78 to 1.12) and was 27% higher for transapical TAVI (OR 1.27; 95% CI 1.02 to 1.57). Cumulative costs (index plus readmission costs) were 13% (β 0.13; 95% CI 0.10 to 0.15) and 19% (β 0.19; 95% CI 0.16 to 0.23) higher for the endovascular TAVI and transapical TAVI, respectively. In conclusion, the rate of readmissions was similar for endovascular TAVI and SAVR but the costs were 26% higher for TAVI than for SAVR.