MD3 - Adoption of Transcatheter Mitral Valve Repair in Germany: Utilization Patterns and Case Volumes Compared to Mitral Valve Surgery in the Period 2010-2014

Abstract

The German healthcare system was among the first markets to introduce transcatheter mitral valve repair (TMVR) in routine care for patients suffering from mitral valve insufficiency. Our objective was to estimate the impact of TMVR availability on overall mitral valve repair volumes and competing therapies in this real-world setting. Therapy- and age-specific procedure volumes were collected from German Federal Statistics Office databases for TMVR and mitral valve surgery for the period 2010 through 2014. We computed therapy-specific and total procedure volumes and growth stratified by age groups <65, 65-74, 75-84, and >85 years, and in total. In the time period 2010 to 2014 overall procedure volumes grew from 17,521 to 24,033 (+37%). This growth was driven by both TMVR (508 to 3,715; +631%) and surgical procedure growth (17,013 to 20,318; +19%). The share of TMVR as percent of total procedures grew from 2.9% to 15.5% over the 5-year period. In 2014, TMVR use reached 4%, 13%, 26%, and 68% in the studied age groups. Absolute TMVR procedure growth was highest in age group 75-84 years (+1,606). Concurrently, surgical volumes grew in all age groups, except for age >85 years, with the highest absolute growth in younger patients (+2,079 in age group <65 years). The availability of TMVR has contributed to pronounced growth in mitral valve repair in Germany, specifically in elderly populations previously left untreated. At the same time, surgical procedure volumes continued to grow substantially in the study period in all age segments, except for the group of very elderly patients.