TAVR is goedkoper dan SAVR bij ernstige aortaklepstenose — kostenanalyse in commerciële verzekering

BACKGROUND: Patients with aortic stenosis (AS) have been shown to have lower costs at 1 year with transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in a Medicare population. The difference in costs between TAVR and SAVR in commercially insured patients with AS in the United States is unknown. METHODS: Using the Optum claims database, AS patients receiving either TAVR or SAVR between 3/2019 and 9/2022 were identified. Patients were categorized into low, intermediate or high strata using the Hospital Frailty Risk Score (HFRS). The primary outcome was total 1-year cost, defined as the sum of index AVR hospitalization and 1-year follow-up costs. Risk-adjusted generalized linear models were used to assess the difference in the costs between TAVR and SAVR. RESULTS: 3,623 patients (952 TAVR; 2,671 SAVR) were identified. TAVR patients had lower index hospitalization costs compared with SAVR patients across all HFRS strata (cost difference for low: $39,312, p < 0.01; intermediate: $42,006, p < 0.01; high: $39,431, p = 0.03). Cumulative costs through one year were significantly lower with TAVR in the low and intermediate HFRS strata (cost difference for low: $32,116, p < 0.01; intermediate $40,905, p < 0.01) and numerically lower in the high HFRS stratum (cost difference: $35,881, p = 0.15). When the analysis was restricted to isolated AVR, the 1-year difference was no longer significant in the low and intermediate HFRS strata ($8,064 and $11,314, respectively) and was numerically reversed in the high HFRS stratum (-$28,804). CONCLUSIONS: In a commercial payor population of real-world patients with AS, TAVR was associated with lower standardized index hospitalization costs across all HFRS strata and lower standardized 1-year costs in the low and intermediate HFRS strata. These findings demonstrate that baseline frailty and procedural scope are critical determinants of short and intermediate-term cost differences between TAVR and SAVR for the treatment of AS in commercial populations.