OBJECTIVES:

Given TAVR’s broadening application, the budget constraints faced by hospitals, and the higher cost of the TAVR valve compared to SAVR, there is great interest in understanding how hospital costs compare between TAVR and SAVR.

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 – September 30, 2016 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 2016 dollars.

We supplemented this aggregate-level cost analysis by examining the average in-hospital costs and reimbursement for TAVR and SAVR at two U.S. hospitals.

RESULTS:

We matched 10,315 TAVR and SAVR patients in the Premier Database. The average, unadjusted, total in-patient hospital cost for TAVR was $64,114 (SD=$35,860) compared to $66,996 (SD=$48,886) for SAVR. The total average supply cost was higher for TAVR by $21,709 (TAVR=$37,486, SD: $21,770 versus SAVR=$15,777, SD: $12,345). TAVR had lower average differences of $10,166 for room and board costs (TAVR=$11,008 versus SAVR=$21,174); $5,813 for operating room costs (TAVR=$7,087 versus SAVR=$12,900); and $2,865 for lab costs (TAVR=$1,670 versus SAVR=$4,535).

CONCLUSIONS:

Average, total in-hospital cost for TAVR was slightly lower compared to SAVR, mainly resulting from the lower costs for room and board and the operating room helping to offset the higher supply cost for TAVR.