Analysis of the additional costs of clinical complications in patients undergoing transcatheter aortic valve replacement in the German Health Care System

作者：Gutmann Anja; Kaier Klaus^*; Sorg Stefan; Muehlen Constantin von zur; Siepe Matthias; Moser Martin; Geibel Annette; Zirlik Andreas; Ahrens Ingo; Baumbach Hardy; Beyersdorf Friedhelm; Vach Werner; Zehender Manfred; Bode Christoph; Reinoehl Jochen

来源：International Journal of Cardiology, 2015, 179: 231-237.

DOI：10.1016/j.ijcard.2014.11.095

• TAVI
• TAVR
• Resource utilization
• Cost analysis
• VARC complication

Background: This study aims at analyzing complication-induced additional costs of patients undergoing transcatheter aortic valve replacement (TAVR).
Methods: In a prospective observational study, a total of 163 consecutive patients received either transfemoral (TF-, n = 97) or transapical (TA-) TAVR (n = 66) between February 2009 and December 2012. Clinical endpoints were categorized according to VARC-2 definitions and in-hospital costs were determined from the hospital perspective. Finally, the additional costs of complications were estimated using multiple linear regression models.
Results: TF-TAVR patients experienced significantly more minor access site bleeding, major non-access site bleeding, minor vascular complications, stage 2 acute kidney injury (AKI) and permanent pacemaker implantation. Total in-hospital costs did not differ between groups and were on average (sic)40,348 (SD 15,851) per patient. The average incremental cost component of a single complication was (sic)3438 (p < 0.01) and the estimated cost of a TF-TAVR without complications was (sic)34,351. The complications associated with the highest additional costs were life-threatening non-access site bleeding ((sic)47,494; p < 0.05), stage 3 AKI ((sic)20,468; p < 0.01), implantation of a second valve ((sic)16,767; p < 0.01) and other severe cardiac dysrhythmia ((sic)10,611 p < 0.05). Overall, the presence of complication-related in-hospital mortality increased costs.
Conclusions: Bleeding complications, severe kidney failure, and implantation of a second valve were the most important cost drivers in our TAVR patients. Strategies and advances in device design aimed at reducing these complications have the potential to generate significant in-hospital cost reductions for the German Health Care System.

• 出版日期2015-1-20