Estimating the additional costs per life saved due to transcatheter aortic valve replacement: a secondary data analysis of electronic health records in Germany

  • Klaus Kaier
  • Constantin von zur Mühlen
  • Andreas Zirlik
  • Wolfgang Bothe
  • Philip Hehn
  • Manfred Zehender
  • Christoph Bode
  • Peter StachonEmail author
Original Paper


Aortic stenosis (AS) is the most common valvular heart disease, with a dismal prognosis when untreated. Recommended therapy is surgical (SAVR) or transcatheter (TAVR) aortic valve replacement. Based on a retrospective cohort of isolated SAVR and TAVR procedures performed in Germany in 2015 (N = 17,826), we examine the impact of treatment selection on in-hospital mortality and total in-hospital costs for a variety of at-risk populations. Since patients were not randomized to the two treatment options, the two endpoints in-hospital mortality and reimbursement are analyzed using logistic and linear regression models with 20 predefined patient characteristics as potential confounders. Incremental cost-effectiveness ratios were calculated as a ratio of the risk-adjusted reimbursement and mortality differences with 95% confidence intervals obtained by Fieller’s theorem. Our study shows that TF-TAVR is more costly that SAVR and that cost differences between the procedures vary little between patient groups. Results regarding in-hospital mortality are mixed. SAVR is the predominant procedure among younger patients. For patients older than 85 years or at intermediate and higher pre-operative risk TF-TAVR seems to be the treatment of choice. Incremental cost-effectiveness ratios (ICER) are most favorable for patients older than 85 years (ICER €154,839, 95% CI €89,163–€302,862), followed by patients at higher pre-operative risk (ICER €413,745, 95% CI €258,027–€952,273). A hypothetical shift from SAVR towards TF-TAVR among patients at intermediate pre-operative risk is associated with a less favorable ICER (€1,486,118, 95% CI €764,732–€23,692,323), as the risk-adjusted mortality benefit is relatively small (− 0.97% point), while the additional reimbursement is still eminent (+€14,464). From a German healthcare system payer’s perspective, the additional costs per life saved due to TAVR are most favorable for patients older than 85 and/or at higher pre-operative risk.


Transcatheter aortic valve replacement Surgical aortic valve replacement Cost ICER 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

10198_2018_1023_MOESM1_ESM.pdf (43 kb)
Supplementary material 1 (PDF 42 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Klaus Kaier
    • 1
    • 2
  • Constantin von zur Mühlen
    • 2
  • Andreas Zirlik
    • 2
    • 4
  • Wolfgang Bothe
    • 3
  • Philip Hehn
    • 1
  • Manfred Zehender
    • 2
  • Christoph Bode
    • 2
  • Peter Stachon
    • 2
    Email author return OK on get
  1. 1.Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
  2. 2.Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
  3. 3.Department of Cardiac and Vascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
  4. 4.Department of CardiologyMedical University of GrazGrazAustria

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