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 Mühlen, Andreas Zirlik, Wolfgang Bothe, Philip Hehn, Manfred Zehender, Christoph Bode and Peter Stachon ()
Additional contact information
Klaus Kaier: University of Freiburg
Constantin Mühlen: University of Freiburg
Andreas Zirlik: University of Freiburg
Wolfgang Bothe: University of Freiburg
Philip Hehn: University of Freiburg
Manfred Zehender: University of Freiburg
Christoph Bode: University of Freiburg
Peter Stachon: University of Freiburg

The European Journal of Health Economics, 2019, vol. 20, issue 4, No 12, 625-632

Abstract: Abstract 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.

Keywords: Transcatheter aortic valve replacement; Surgical aortic valve replacement; Cost; ICER (search for similar items in EconPapers)
Date: 2019
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
http://link.springer.com/10.1007/s10198-018-1023-x Abstract (text/html)
Access to the full text of the articles in this series is restricted.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:spr:eujhec:v:20:y:2019:i:4:d:10.1007_s10198-018-1023-x

Ordering information: This journal article can be ordered from
http://www.springer. ... cs/journal/10198/PS2

DOI: 10.1007/s10198-018-1023-x

Access Statistics for this article

The European Journal of Health Economics is currently edited by J.-M.G.v.d. Schulenburg

More articles in The European Journal of Health Economics from Springer, Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ) Contact information at EDIRC.
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().