OBJECTIVES:

To evaluate the overall inpatient hospital costs between TAVR and SAVR, and the evolution of costs over time.

METHODS:

To evaluate in-hospital costs across U.S. hospitals, we conducted a retrospective analysis of patients undergoing TAVR or SAVR between January 1, 2014 – December 31, 2017 using the Premier Hospital Database. Patients were included in the study if they underwent a TAVR or SAVR procedure based on ICD-9 and -10 procedure codes and were 65 years or older at the time of the procedure. Patients were matched 1:1 using propensity score method based on patient age, Charlson comorbidity index grouping (4 indices), gender, race, and payor type. In-hospital costs were defined as the total hospitalization cost including operating room, supply, room and board, ICU, lab, etc. plus pharmacy cost, adjusted to 2017 dollars.

RESULTS:

We matched 23,210 TAVR and SAVR patients. The average, unadjusted, total inpatient hospital cost for TAVR decreased 21% from $67,995 in 2014 (SD=$39,877) to $53,467 (SD=$25,737) and for SAVR decreased 9% from $67,360 (SD=$45,846) to $61,222 (SD=$62,573). The average total costs for TAVR have been similar to SAVR since 2015, despite a higher average supply cost for TAVR (in 2017, TAVR=$35,791, SD: $19,118 versus SAVR=$15,099, SD: $11,227). TAVR had lower average costs in many cost centers, including room and board (in 2017, TAVR=$6,045 versus SAVR=$17,438); operating room (TAVR=$6,019 versus SAVR=$12,662); and lab (TAVR=$951 versus SAVR=$3,849). Average length of stay for TAVR has decreased 50.7% from 7.59 days (SD=7.49) in 2014 to 3.74 days (SD=4.6) in 2017, while average length of stay for SAVR has decreased 17% from 12.36 days (SD=9.85) to 10.26 days (SD=8.46).

CONCLUSIONS:

Average in-hospital costs between TAVR and SAVR have become more comparable each year resulting from lower costs across multiple cost centers offsetting the higher supply cost for TAVR.