Background: The financial impact of transcatheter aortic valve replacement (TAVR) in the US remains unknown. A rigorous comparison to surgical aortic valve replacement (SAVR) costs and payments is warranted.
Methods: Medicare claims provided hospital charges and Medicare payments for patients undergoing SAVR or TAVR between January and December 2012. Hospital-specific cost-to-charge ratios were used to estimate hospital costs. Charges, payments, and costs were examined in a group of TAVR and SAVR patients propensity-matched by age, sex, and common comorbidities (n=3281 pairs).
Results: In the propensity-matched sample, Medicare payments were lower for TAVR hospitalizations ($52,200 ± $28,200) than for SAVR hospitalizations ($56,300 ± $32,600, p<0.001). Estimated hospital costs were not significantly different between TAVR ($55,700 ± $26,700) and SAVR ($54,700 ± $36,600) hospitalizations (p=0.185). The difference between estimated hospital costs and payer reimbursements was greater for TAVR hospitalizations ($2,800 ± $23,500, representing a net loss) than for SAVR hospitalizations (-$2,600 ± $18,500, representing a net profit, p<0.01). Post-procedure length of stay was significantly shorter for TAVR patients than for SAVR patients (6.6 ± 5.6 days vs. 10.0 ± 8.1 days, p<0.001). The same was true for total ICU stay (TAVR 3.4 ± 5.1 days vs. SAVR 6.2 ± 8.2 days, p <0.001).
Conclusions: Among similarly high-risk patients, Medicare pays more on average for SAVR index hospitalizations than for TAVR index hospitalizations. Conversely, SAVR hospitalizations represent a net profit to providers, whereas TAVR hospitalizations represent a net loss. The magnitude of this loss may affect the future growth of TAVR programs as well as the diffusion of other, new high-cost cardiovascular interventions.