Economic Justification Analysis of Minimally Invasive versus Conventional Aortic Valve Replacement

Marko Jovanovic, Igor Zivkovic, Milos Jovanovic, Ilija Bilbija, Masa Petrovic (), Jovan Markovic, Ivana Radovic, Ana Dimitrijevic and Ivan Soldatovic
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Marko Jovanovic: Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
Igor Zivkovic: Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
Milos Jovanovic: Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
Ilija Bilbija: Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
Masa Petrovic: Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
Jovan Markovic: Faculty of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
Ivana Radovic: Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
Ana Dimitrijevic: Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
Ivan Soldatovic: Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia

IJERPH, 2023, vol. 20, issue 3, 1-11

Abstract: There is no definitive consensus about the cost-effectiveness of minimally invasive aortic valve replacement (AVR) (MI-AVR) compared to conventional AVR (C-AVR). The aim of this study was to compare the rate of postoperative complications and total hospital costs of MI-AVR versus C-AVR overall and by the type of aortic prosthesis (biological or mechanical). Our single-center retrospective study included 324 patients over 18 years old who underwent elective isolated primary AVR with standard stented AV prosthesis at the Institute for Cardiovascular Diseases “Dedinje” between January 2019 and December 2019. Reintervention, emergencies, combined surgical interventions, and patients with sutureless valves were excluded. In both MI-AVR and C-AVR, mechanical valve implantation contributed to overall reduction of hospital costs with equal efficacy. The cost-effectiveness ratio indicated that C-AVR is cheaper and yielded a better clinical outcome with mechanical valve implantation (67.17 vs. 69.5). In biological valve implantation, MI-AVR was superior. MI-AVR patients had statistically significantly higher LVEF and a lower Euro SCORE than C-AVR patients (Mann–Whitney U-test, p = 0.002 and p = 0.002, respectively). There is a slight advantage to MI-AVR vs. C-AVR, since it costs EUR 9.44 more to address complications that may arise. Complications (mortality, early reoperation, cerebrovascular insult, pacemaker implantation, atrial fibrillation, AV block, systemic inflammatory response syndrome, wound infection) were less frequent in the MI-AVR, making MI-AVR more economically justified than C-AVR (18% vs. 22.1%).

Keywords: healthcare economics and organizations; heart valve prosthesis implantation; cardiac surgical procedures; aortic valve stenosis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:20:y:2023:i:3:p:2553-:d:1052806

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