Relative profitability of transcatheter versus surgical aortic valve replacement in a high-volume French hospital

Abstract

Current tendency in scientific guidelines trend to extend transcatheter aortic valve replacement (TAVR) indication in intermediate risk patients, who were so far eligible for conventional surgery. We previously demonstrated the high profitability of TAVR, in association with elevated costs. The relative profitability of both techniques has not been studied yet. The objective of this study was to assess the relative profitability of TAVR procedure vs. conventional surgery in a high-volume French hospital. Consecutive patients eligible for transfemoral TAVR or surgical aortic valve replacement (SAVR) were included retrospectively in this single-centre study between September 2014 and December 2015. The primary clinical endpoint was the difference between hospital costs and revenues, calculated for each patient. Secondary composite endpoints included major adverse events within 30 days after procedure and breakdown of costs. 210 patients were included in the TAVR group and 341 in the SAVR group. TAVR patients presented higher operative risk scores and more comorbidities. Four TAVR patients and 7 SAVR patients died within 30 days of the procedure ( P = 0.74). The mean profitability was €2732 ± 1768 per TAVR patient vs. €2177 ± 2437 per SAVR patient ( P < 0.001). TAVR total cost was €27.778 ± 4961 per patient, whereas SAVR cost was €17.813 ± 6071 per patient ( P < 0.001) The price of the bioprosthesis represented 70% of the TAVR costs ( Fig. 1 ). In carefully selected patients, the TAVR procedure was associated with a higher profitability than SAVR, but also with significantly higher costs. Most of TAVR costs were related to the prosthesis price, whereas surgical costs were balanced.