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The comparison of the clinical outcomes and costs between surgical aortic valve replacement and transcatheter aortic valve implantation based on the Japanese Diagnosis Procedure Combination database

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Abstract

Purpose

We evaluated the clinical outcomes and costs of surgical aortic valve replacement (SAVR) and transfemoral transcatheter aortic valve implantation (TAVI) for aortic stenosis using the Japanese Diagnosis Procedure Combination (DPC) database.

Methods

Using our extraction protocol, we retrospectively analyzed summary tables in the DPC database from 2016 to 2019, which were provided by the Ministry of Health, Labor and Welfare. A total of 27,278 patients were available (SAVR, n = 12,534; TAVI, n = 14,744).

Results

The TAVI group was older than the SAVR group (SAVR vs. TAVI: 74.6 vs. 84.5 years; P < 0.01), with a lower in-hospital mortality (1.0 vs. 0.6%; P < 0.01) and a shorter hospital stay (26.9 vs. 20.3 days; P < 0.01). TAVI conferred more total medical service reimbursement points than SAVR (493,944 vs. 605,241 points; P < 0.01), especially materials points (147,830 vs. 434,609 points; P < 0.01). Total insurance claims for TAVI were approximately 1 million yen higher than those for SAVR. Regarding the details of costs, only the operation cost was higher, while other costs were lower with TAVI than with SAVR.

Conclusion

Our analysis revealed that both SAVR and TAVI showed acceptable clinical outcomes. TAVI was associated with higher total insurance claims than SAVR. If the material cost of TAVI operations can be reduced, greater cost-effectiveness can be expected.

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Data availability

The data that support the findings of this study are available from the Ministry of Health, Labor and Welfare (MHLW). Restrictions apply to the availability of these data, which were used after passing the screening process for this study. Data are available from the corresponding author with the permission of the MHLW.

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Acknowledgements

We appreciate the support of Professor Chisato Shimanoe from the Department of Pharmacy, Saga University Hospital, Saga, Japan in relation to the statistical methods of the present study.

Funding

This work was supported by JSPS KAKENHI Grant Numbers JP15K08850 and JP18K08764).

Author information

Authors and Affiliations

  1. Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan

    Junji Yunoki, Nagi Hayashi, Kouki Jinnouchi, Hiroyuki Morokuma, Manabu Itoh & Keiji Kamohara

  2. Junshin Gakuen University, Fukuoka, Japan

    Shigeki Morita

Authors
  1. Junji Yunoki
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  2. Shigeki Morita
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  3. Nagi Hayashi
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  4. Kouki Jinnouchi
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  5. Hiroyuki Morokuma
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  6. Manabu Itoh
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  7. Keiji Kamohara
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Corresponding author

Correspondence to Junji Yunoki.

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Conflict of interest

Junji Yunoki and other coauthors declare no conflicts of interest in association with the present study.

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Clinical Research Ethics Review Committee of The Saga University Faculty of Medicine (Reference Number: 2021-01-R-05).

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Appendix: Annual Clinical Outcome and Medical Cost Data

Appendix: Annual Clinical Outcome and Medical Cost Data

 

SAVR

TAVI

FY2016

FY2017

FY2018

FY2016

FY2017

FY2018

Number of patients

4232

4303

3999

3099

5068

6577

Age (years)

74.8 ± 7.9

74.7 ± 8.0

74.4 ± 7.8

84.4 ± 5.2

84.6 ± 5.1

84.5 ± 5.2

Male sex: n (%)

1865 (44.1)

1941 (45.1)

1871 (46.8)

990 (31.9)

1520 (30.0)

2059 (31.3)

Preoperative LOS (days)

5.2 ± 5.6

5.2 ± 5.5

5.1 ± 5.8

7.1 ± 9.7

7.2 ± 10.5

6.9 ± 9.4

Postoperative LOS (days)

22.1 ± 16.7

21.6 ± 15.7

21.3 ± 14.7

13.5 ± 11.4

13.3 ± 12.1

13.0 ± 12.3

Total LOS (days)

27.4 ± 18.2

26.8 ± 17.4

26.4 ± 16.6

20.6 ± 16.4

20.5 ± 17.8

19.9 ± 16.9

In-hospital mortality (%)

1.28 (54/4232)

0.91 (39/4303)

0.80 (32/3999)

0.68 (21/3099)

0.71 (36/5068)

0.49 (32/6577)

Medical service reimbursement points (points)

Total

489,824 ± 206,937

494,902 ± 207,874

497,272 ± 200,292

606,089 ± 207,574

607,694 ± 201,745

602,952 ± 189,923

Drugs

29,265 ± 36,330

29,154 ± 40,711

28,578 ± 33,048

8,655 ± 18,155

7,777 ± 18,167

6,661 ± 23,990

Materials

147,646 ± 50,226

149,203 ± 52,986

146,549 ± 49,954

431,636 ± 126,334

435,647 ± 116,953

435,210 ± 104,490

Medical costs (yen)

Operation

3,186,301 ± 649,809

3,204,192 ± 732,577

3,177,055 ± 684,764

5,049,085 ± 926,401

5,038,286 ± 904,679

4,963,165 ± 902,556

Anesthesia

333,171 ± 193,386

331,577 ± 187,550

346,005 ± 203,186

130,648 ± 232,810

132,725 ± 291,217

154,039 ± 411,918

Injection

143,846 ± 337,817

139,686 ± 353,342

120,978 ± 268,055

48,995 ± 128,736

49,530 ± 176,361

41,542 ± 181,882

Oral medication

12,713 ± 23,638

12,552 ± 18,431

12,638 ± 23,927

11,349 ± 20,843

11,833 ± 35,620

10,724 ± 23,991

Clinical examination

114,426 ± 90,208

111,516 ± 85,614

109,388 ± 81,291

104,683 ± 86,704

105,166 ± 85,321

106,503 ± 90,616

Imaging examination

49,689 ± 45,061

49,078 ± 44,191

48,523 ± 41,719

51,700 ± 47,492

49,068 ± 44,666

47,638 ± 47,175

Hospitalization

839,819 ± 475,810

847,603 ± 471,824

863,965 ± 461,309

596,698 ± 429,148

585,452 ± 459,306

583,972 ± 440,255

Continuous data are shown as the mean ± standard deviation.

FY, fiscal year; LOS, length of hospital stay; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation.

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Yunoki, J., Morita, S., Hayashi, N. et al. The comparison of the clinical outcomes and costs between surgical aortic valve replacement and transcatheter aortic valve implantation based on the Japanese Diagnosis Procedure Combination database. Surg Today 54, 240–246 (2024). https://doi.org/10.1007/s00595-023-02722-9

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  • DOI: https://doi.org/10.1007/s00595-023-02722-9

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