Skip to main content

Advertisement

SpringerLink
Log in

Cost analysis of transcatheter versus surgical aortic valve replacement in octogenarians: analysis from a single Japanese center

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Transcatheter aortic valve replacement (TAVR) has revolutionized the prognosis of intermediate- or high-risk patients with severe aortic stenosis, particularly among older adults. However, in possible candidates for surgical aortic valve replacement (SAVR), the implantation of expensive prostheses may be questionable in an era when healthcare costs are becoming a major concern. In this retrospective analysis of a single Japanese center, we focused on patients aged over 80 years; the objectives of this study were: (1) to compare TAVR and SAVR in terms of total hospitalization costs and (2) to describe the itemized cost of TAVR and SAVR to identify patients aged over 80 years in whom TAVR or SAVR would be cost-effective. A total of 146 patients aged over 80 years who underwent TAVR or SAVR for severe aortic stenosis were included. These patients were divided into a high-risk group (Society of Thoracic Surgeons [STS] mortality score > 8%; 36: TAVR and 12: SAVR) with 48 patients and a non-high-risk group (STS mortality score < 8%; 45: TAVR and 53 SAVR) with 98 patients. No 30-day mortality was observed in either group. In both groups, postoperative intensive care unit stay and hospital stay were longer with SAVR than with TAVR. In the non-high-risk group, the total cost was comparable for TAVR and SAVR; however, in the high-risk group, the total cost was significantly higher with SAVR than that with TAVR. A breakdown analysis of the total cost in the high-risk group showed both pre- and postoperative costs to be significantly higher with SAVR than with TAVR; however, operative costs were higher with TAVR. Up to 3 years, the overall survival in both groups did not significantly differ between TAVR and SAVR. Our findings suggest that from the perspective of total medical costs, TAVR is more suitable than SAVR for high-risk older adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, Derumeaux G, Anselme F, Laborde F, Leon MB (2002) Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 106:3006–3008

    Article  Google Scholar 

  2. Bohula May EA, Faxon D (2013) Transcatheter aortic valve replacement: history and current status. Trends Cardiovasc Med 23:172–178

    Article  Google Scholar 

  3. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ, PARTNER Trial Investigators (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187–2198

    Article  CAS  Google Scholar 

  4. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S, PARTNER Trial Investigators (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607

    Article  CAS  Google Scholar 

  5. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG, PARTNER 2 Investigators (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374:1609–1620

    Article  CAS  Google Scholar 

  6. Reynolds MR, Magnuson EA, Wang K, Lei Y, Vilain K, Walczak J, Kodali SK, Lasala JM, O’Neill WW, Davidson CJ, Smith CR, Leon MB, Cohen DJ, PARTNER Investigators (2012) Cost-effectiveness of transcatheter aortic valve replacement compared with standard care among inoperable patients with severe aortic stenosis: results from the placement of aortic transcatheter valves (PARTNER) trial (Cohort B). Circulation 125:1102–1109

    Article  Google Scholar 

  7. Gadey G, Reynolds MR (2014) Cost-effectiveness considerations in transcatheter management of valvular heart disease. Can J Cardiol 30:1058–1063

    Article  Google Scholar 

  8. Clark MA, Arnold SV, Duhay FG, Thompson AK, Keyes MJ, Svensson LG, Bonow RO, Stockwell BT, Cohen DJ (2012) Five-year clinical and economic outcomes among patients with medically managed severe aortic stenosis: results from a Medicare claims analysis. Circ Cardiovasc Qual Outcomes 5:697–704

    Article  Google Scholar 

  9. Minutello RM, Wong SC, Swaminathan RV, Feldman DN, Kaple RK, Horn EM, Devereux RB, Salemi A, Sun X, Singh H, Bergman G, Kim LK (2015) Costs and in-hospital outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement in commercial cases using a propensity score matched model. Am J Cardiol 115:1443–1447

    Article  Google Scholar 

  10. Pollak PM, Mack MJ, Holmes DR Jr (2014) Quality, economics, and national guidelines for transcatheter aortic valve replacement. Prog Cardiovasc Dis 56:610–618

    Article  Google Scholar 

  11. Boothroyd LJ, Spaziano M, Guertin JR, Lambert LJ, Rodés-Cabau J, Noiseux N, Nguyen M, Dumont É, Carrier M, de Varennes B, Ibrahim R, Martucci G, Xiao Y, Morin JE, Bogaty P (2013) Transcatheter aortic valve implantation: recommendations for practice based on a multidisciplinary review including cost-effectiveness and ethical and organizational issues. Can J Cardiol 29:718–726

    Article  Google Scholar 

  12. Tam DY, Hughes A, Fremes SE, Youn S, Hancock-Howard RL, Coyte PC, Wijeysundera HC (2018) A cost-utility analysis of transcatheter versus surgical aortic valve replacement for the treatment of aortic stenosis in the population with intermediate surgical risk. J Thorac Cardiovasc Surg 155(1978–1988):E1

    Google Scholar 

  13. Kularatna S, Byrnes J, Mervin MC, Scuffham PA (2016) Health technology assessments reporting cost-effectiveness of transcatheter aortic valve implantation. Int J Technol Assess Health Care 32:89–96

    Article  Google Scholar 

  14. Yokoyama H, Tobaru T, Muto Y, Hagiya K, Higuchi R, Saji M, Takamisawa I, Shimizu J, Takanashi S, Takayama M, Tomita H, Tamura H, Doi S, Okazaki S, Isobe M (2019) Long-term outcomes in Japanese nonagenarians undergoing transcatheter aortic valve implantation: a multi-center analysis. Clin Cardiol 42:605–611

    Article  Google Scholar 

  15. Yamamoto M, Watanabe Y, Tada N, Naganuma T, Araki M, Yamanaka F, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Shirai S, Hayashida K, OCEAN-TAVI investigators (2019) Transcatheter aortic valve replacement outcomes in Japan: Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry. Cardiovasc Revasc Med 20:843–851

    Article  Google Scholar 

  16. McCarthy FH, Savino DC, Brown CR, Bavaria JE, Kini V, Spragan DD, Dibble TR, Herrmann HC, Anwaruddin S, Giri J, Szeto WY, Groeneveld PW, Desai ND (2017) Cost and contribution margin of transcatheter versus surgical aortic valve replacement. J Thorac Cardiovasc Surg 154:1872-1880.e1

    Article  Google Scholar 

  17. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, Leipsic J, Hahn RT, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Genereux P, Pershad A, Pocock SJ, Alu MC, Webb JG, Smith CR, PARTNER 3 Investigators (2019) Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 380:1695–1705

    Article  Google Scholar 

  18. Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG, Yoon SH, Trento A, Svensson LG, Herrmann HC, Szeto WY, Miller DC, Satler L, Cohen DJ, Dewey TM, Babaliaros V, Williams MR, Kereiakes DJ, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Brown DL, Fearon WF, Russo MJ, Pibarot P, Hahn RT, Jaber WA, Rogers E, Xu K, Wheeler J, Alu MC, Smith CR, Leon MB, PARTNER 2 Investigators (2020) Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med 382:799–809

    Article  Google Scholar 

  19. Padang R, Ali M, Greason KL, Scott CG, Indrabhinduwat M, Rihal CS, Eleid MF, Nkomo VT, Pellikka PA, Pislaru SV (2018) Comparative survival and role of STS score in aortic paravalvular leak after SAVR or TAVR: a retrospective study from the USA. BMJ Open 8:e022437

    Article  Google Scholar 

  20. Matsushita K, Kanso M, Ohana M, Marchandot B, Kibler M, Heger J, Peillex M, Trimaille A, Hess S, Grunebaum L, Reydel A, De Poli F, Leddet P, Rischner J, Plastaras P, Jesel L, Morel O, Ohlmann P (2020) Periprocedural predictors of new-onset conduction abnormalities after transcatheter aortic valve replacement. Circ J 84:1875–1883

    Article  CAS  Google Scholar 

  21. Sepehri A, Beggs T, Hassan A, Rigatto C, Shaw-Daigle C, Tangri N, Arora RC (2014) The impact of fraility on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg 148:3110–3117

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the other members of the TAVR team––Koichi Matsubara, MD, Ph.D. and Kensuke Nakamura, MD––for their excellent support in echocardiography.

Funding

None.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan

    Takeshi Onohara, Yasushi Yoshikawa, Yuichiro Kishimoto, Shingo Harada, Hiromu Horie, Kunitaka Kumagai, Rikuto Nii & Motonobu Nishimura

  2. Division of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan

    Tomomi Watanabe & Kazuhiro Yamamoto

Authors
  1. Takeshi Onohara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasushi Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomomi Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuichiro Kishimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shingo Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiromu Horie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kunitaka Kumagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rikuto Nii
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kazuhiro Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Motonobu Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

To design the study, performed the research, analyzed the data, and wrote the first draft of the manuscript. TW, SH, HH, KK, and RN performed the TAVR and SAVR procedures and collected the data. KY carried out the statistical analysis. YY, KY, and MN designed the study, discussed the results, and revised the manuscript. All the authors approved the final version of the manuscript for publication.

Corresponding author

Correspondence to Yasushi Yoshikawa.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments.

Informed consent

A waiver of informed consent was granted, as all the collected data existed in the medical records, and there was no contact with patients and study-related interventions were not performed.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Onohara, T., Yoshikawa, Y., Watanabe, T. et al. Cost analysis of transcatheter versus surgical aortic valve replacement in octogenarians: analysis from a single Japanese center. Heart Vessels 36, 1558–1565 (2021). https://doi.org/10.1007/s00380-021-01826-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-021-01826-x

Keywords

Search

Navigation