Assessment of Outcomes and Cost of Complications following Surgical and Transcatheter Aortic Valve Replacement 公开

Forcillo, Jessica (Fall 2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/4m90dv48q?locale=zh
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Abstract

  

BACKGROUND: TAVR and SAVR are two well-adopted therapies for the treatment of severe aortic stenosis. However, the clinical and economic cost of complications of these procedures have been less understood. The purpose of this study is to assess outcomes and costs associated with complications following TAVR and SAVR.

 

METHODS: 3,337 patients undergoing SAVR (N=1,765) or TAVR (N=1,572) from 1/2011 and 1/2017 were included in this retrospective analysis from an academic US institution. The complications included the neurological, respiratory, cardiovascular, renal and gastrointestinal systems. Logistic regression models were built to examine two associations: 1) cost and complications and 2) 30-day mortality and complications. Differential cost between SAVR and TAVR were calculated excluding and including the cost of the implant stratified by the number of complications.

 

RESULTS: Median age was 82 (76-86) years for TAVR and 70 (62-77) years for SAVR. Majority of patients were male and median STS score was 9.6% (IQR: 4.6-14.3) for TAVR and 2.8% (IQR: 1.6-4.8) for SAVR. The 30-day mortality was 3.9% for TAVR and 3.1% for SAVR. The mean number of complications for TAVR was 1.3 and SAVR 2.2. When excluding the cost of the implant, the SAVR cost was more than TAVR by $650 for patients who had 1 complication; $104 for 2 complications; $1,862 for 3; $158 for 4; and $6,147 for ≥ 5. Including the cost of the implants, the TAVR cost was more than SAVR by $ 26,523 for patients who had 1 complication; $28,066 for 2 complications; $27,095 for 3; $30,458 for 4; and $31,060 for ≥ 5. The differential cost between the SAVR and TAVR devices was $25,985.

 

CONCLUSIONS: When the cost of the implant is considered, the costs related to TAVR complications are higher than the costs related to SAVR complications. However, if the cost of the implants is removed, the costs of TAVR complications, even in a high-risk cohort, are much less than the costs of SAVR complications in a low-risk cohort. When the cost of the TAVR implant decreases in the future, the economic advantage of TAVR over SAVR becomes more pronounced.

Table of Contents

 TABLE OF CONTENTS

 

 

 

 

 

 

 

CHAPTER I

Background……………………….………………………..…………… 1

 

CHAPTER II (Manuscript)....................................................................... 9

Abstract.....................................................................................................11

Introduction.............................................................................................. 12

Methods.................................................................................................... 14

Results...................................................................................................... 17

Discussion................................................................................................ 19

Conclusions.............................................................................................. 25

 

 

 

CHAPTER III

Discussion................................................................................................ 26

 

 

 

CHAPTER IV

Public Health Implications and Future Directions................................... 31

 

LIMITATIONS........................................................................................ 32

 

CONCLUSIONS...................................................................................... 33

 

 

 

REFERENCES………..………………………………………………... 34

 

TABLES

Table 1...................................................................................................... 37

Table 2...................................................................................................... 38

Table 3...................................................................................................... 40

Table 4...................................................................................................... 41

Table 5...................................................................................................... 42

Table 6...................................................................................................... 42

Table 7...................................................................................................... 42

Table 8...................................................................................................... 43

Table 9...................................................................................................... 44

Table 10.................................................................................................... 44

 

 

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