Optimized Patient Pathway for Aortic Stenosis Patients: The Economic and Clinical Implications

OBJECTIVES: Reorganizing hospital resources to address the growing need for aortic stenosis (AS) treatments is crucial, also due to new treatment indications. This study evaluates the resource consumption of an optimized patient pathway for aortic stenosis, known as "day service," at "Ospedale del Cuore" in Massa, Italy, recognized for its efficient multidisciplinary management system.

METHODS: The Activity-Based Costing method was used to analyze patient pathway costs and staff time, based on interviews with clinical and administrative staff. Unit costs of drugs, consumables, procedures, visits, and hospital stays were provided by the center, while imaging, blood tests, and specific test costs were identified through Toscana regional tariffs.

RESULTS: The analysis revealed the total time spent by each staff member on TAVI patient management. The length of stay (LOS) was reduced from 7.9 days to 6 days with the optimized pathway, resulting in a cost difference of €1,291.34 per patient. Additionally, this pathway positively impacted mortality rates. The assessment of frailty, as reported by Mazzone et al. 2023 for the same day service pathway, allows for the identification of the best candidates for AS treatment: pre-frail/early frail patients appear to be ideal candidates for surgical procedures such as TAVI, with a high survival rate in the mid-term.

CONCLUSIONS: The optimized TAVI pathway reduced resource consumption, enabling the hospital to manage more aortic stenosis patients. This also led to shorter waiting lists and faster patient access to care. Careful patient selection, early diagnosis, and clinical appropriateness help identify tailored care pathways. This approach enhances the sustainability of both the hospital and the overall healthcare system.