Healthcare Resource Utilization Comparison of Balloon-Expandable Valve Versus Self-Expandable Valve for Transcatheter Aortic Valve Replacement in China

OBJECTIVES: The balloon-expandable (BE) valve, which is used to treat aortic stenosis (AS), is an approved implant for transcatheter aortic valve replacement (TAVR), showing a clinical advantage over the self-expandable (SE) valve in previous randomized clinical trials. This study aimed to compare the healthcare resources use for these two types of valves, investigating the economic advantages associated with the BE valve.

METHODS: All data were retrospectively derived from a tertiary hospital in Guangzhou, China. Patients who had AS and received TAVR, were identified between July 1, 2020, and December 31, 2022. The baseline characteristics, length of stay and hospitalization expenses of the patients were analyzed.

RESULTS: Study population included 69 patients implanted with BE valves (n=18) and SE valves (n=51). The baseline characteristics, including age, gender, NYHA functional classification, were evenly distributed between two patient groups. The total expenses associated with the BE valve were substantially higher than those of the SE valve, driven by the high cost of the surgery and materials. However, it might be offset by the reduction in the length of stay and the corresponding healthcare resource savings. Patients in the BE valve group had a notably shorter length of stay compared to the SE valve group (12.78 vs 16.73, p=0.03), including a significantly decreased ICU length of stay (1.78 vs 3.61, p=0.02) and a shorter length of postoperative stay (5.44 vs 8.76, p＜0.01). Furthermore, compared with SE group, the BE group demonstrated notable cost savings in medicine expenses, treatment expenses, laboratory costs and nursing fees, by 3,586.26 CNY, 4,102.18 CNY, 2,564.34 CNY, and 606.30 CNY, respectively.

CONCLUSIONS: The real-world evidence indicates the potential economic advantages of the BE valve. Due to the limited sample size of the two study groups, our findings should be validated through a multicentre, large-scale study.