Abstract 19924: National Cost Comparison of Trans Catheter Aortic Valve Replacement With Surgical Aortic Valve Replacement in Moderate to High Risk Patients With Severe Symptomatic Aortic Stenosis in New Zealand
Introduction: AS is a condition with an increasing prevalence in New Zealand (NZ). The natural history of severe AS is such that patients face a poor prognosis once the disease becomes clinically evident. Surgical aortic valve replacement (SAVR) is the standard of care, yet many are at high risk of poor outcomes due to comorbidity, frailty or anatomical limitations. Clinically TAVR may be an appropriate alternative treatment; however, at present it remains an expensive technology: the procurement cost of an Edwards Sapien trans catheter valve is NZD$30,000. Expansion of TAVR could have a major budget impact on the NZ public healthcare system. Conversely, the high cost of the transcatheter valve may be offset by intensive care unit stay and the cost of complications related to SAVR.
Methods: To explore this further, we retrospectively compare index admission cost in AS patients with Euroscore 2 > 4 undergoing SAVR with those having TAVR. Patients were excluded if they had surgery outsourced to the private sector, if they had not had their procedure by 31/3/2014 or if full costing data could not be extracted from the hospital business department. Clinical variables include date of admission, date of procedure, age, gender, weight, Euroscore 2, renal function (GFR), LV function and previous sternotomy. Data was collected across the three TAVR centers in NZ. A total of 170 TAVR patients are compared with 168 SAVR patients.
Initial Results: Mean Euroscore 2 was 9.8 +/- 5.4 in the TAVR group compared with 7.4 +/- 4.3 in the SAVR group. The mean cost of SAVR vs TAVR was $65,793 and $52,582 respectively. Median cost was $54,826 for SAVR and $46,899 for TAVR. 57% of the mean cost of TAVR was due to the valve. Average length of stay in TAVR patients was half that of SAVR patients. ICU cost in SAVR patients was $10,021 higher than in the TAVR patients. On average, TAVR required 10% of the blood product costs associated with SAVR.
Conclusions: We show that the average index admission cost of SAVR is significantly higher than TAVR in this group of patients who were at moderate to high risk of surgery. Also, non-device costs are much higher in SAVR, suggesting higher hospital resource requirements compared to TAVR. This data has implications for TAVR funding in the NZ public healthcare system.
Author Disclosures: S. Bhattacharyya: None. M. Roskruge: None. S. Pasupati: None. G. Devlin: None. D. Smyth: None. M. Webster: None. P. Ruygrok: None.
- © 2014 by American Heart Association, Inc.