Evaluation of PARTNER Trial Shows High Costs of Periprocedural Complications With TAVR

December 19, 2014—Results from an evaluation of costs of periprocedural complications in patients treated with transcatheter aortic valve replacement (TAVR) in the PARTNER trial were published by Suzanne V. Arnold, MD, et al on behalf of the PARTNER investigators in Circulation: Cardiovascular Interventions (2014;7:829–836).

The investigators sought to estimate the effect of periprocedural complications on in-hospital costs and length of stay of TAVR in the context that TAVR improves survival in patients with severe aortic stenosis when compared with nonsurgical therapy, but it has higher in-hospital and lifetime costs. Complications associated with TAVR may decrease with greater experience and improved devices, thereby reducing the overall cost of the procedure, stated the investigators.

As summarized in Circulation: Cardiovascular Interventions, the investigators used detailed cost data from 406 TAVR patients enrolled in the PARTNER I trial to develop multivariable models to estimate the incremental cost and length of stay associated with specific periprocedural complications. Attributable costs and length of stay for each complication were calculated by multiplying the independent cost of each event by its frequency in the treatment group.

The investigators reported that mean cost for the initial hospitalization was $79,619 ± $40,570 ($50,891 excluding the valve); 49% of patients had one or more complications. Seven complications were independently associated with increased hospital costs, with major bleeding, arrhythmia, and death accounting for the largest attributable cost per patient. Renal failure and the need for repeat TAVR, although less frequent, were also associated with substantial incremental and attributable costs. Overall, complications accounted for $12,475 per patient in initial hospital costs and 2.4 days of hospitalization.

The evaluation showed that in the PARTNER trial, periprocedural complications were frequent, costly, and accounted for approximately 25% of nonimplant-related hospital costs. Avoidance of complications should improve the cost-effectiveness of TAVR for inoperable and high-risk patients, but reductions in the cost of uncomplicated TAVR will also be necessary for optimal efficiency, concluded the investigators in Circulation: Cardiovascular Interventions.