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Ann Thorac Surg 2012;94:1954-1960. doi:10.1016/j.athoracsur.2012.07.002
© 2012 The Society of Thoracic Surgeons
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Original Articles: Adult Cardiac

Costs of Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients

Ruben L.J. Osnabrugge, MSca,b, Stuart J. Head, MScb, Tessa S.S. Genders, MSca,c, Nicolas M. Van Mieghem, MDd, Peter P.T. De Jaegere, MD, PhDd, Robert M.A. van der Boon, MScd, J. Marco Kerkvliet, MScb, Bindu Kalesan, PhDe, Ad J.J.C. Bogers, MD, PhDb, A. Pieter Kappetein, MD, PhDb,*, M.G. Myriam Hunink, MD, PhDa,c,f

a Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
b Department of Cardio-Thoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
c Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
d Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
e Department of Social and Preventive Medicine, University of Bern, Switzerland
f Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts

Accepted for publication July 3, 2012.

* Address correspondence to Dr Kappetein, Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, the Netherlands (Email: a.kappetein{at}erasmusmc.nl).

Background: Transcatheter aortic valve replacement (TAVR) offers a new treatment option for patients with aortic stenosis, but costs may play a decisive role in decision making. Current studies are evaluating TAVR in an intermediate-risk population. We assessed the in-hospital and 1-year follow-up costs of patients undergoing TAVR and surgical aortic valve replacement (SAVR) at intermediate operative risk and identified important cost components.

Methods: We prospectively collected clinical data on 141 patients undergoing TAVR and 405 undergoing SAVR. Propensity score matching yielded 42 matched pairs at intermediate risk. Costs were assessed using a detailed resource-use approach and compared using bootstrap methods.

Results: In-hospital costs were higher in TAVR patients than in SAVR patients ({euro}40802 vs {euro}33354, respectively; p = 0.010). The total costs at 1 year were {euro}46217 vs {euro}35511, respectively (p = 0.009). The TAVR was less costly with regard to blood products, operating room use, and length-of-stay.

Conclusions: For intermediate-risk patients with severe aortic stenosis the costs at 1 year are higher for TAVR than for SAVR. The difference was mainly caused by the higher costs of the transcatheter valve and was not compensated by the lower costs for blood products and hospital stay in TAVR patients. Therefore, SAVR remains a clinically and economically attractive treatment option.






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