IDEAS home Printed from https://ideas.repec.org/a/spr/eujhec/v20y2019i4d10.1007_s10198-018-1023-x.html
   My bibliography  Save this article

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

Author

Listed:
  • Klaus Kaier

    (University of Freiburg
    University of Freiburg)

  • Constantin Mühlen

    (University of Freiburg)

  • Andreas Zirlik

    (University of Freiburg
    Medical University of Graz)

  • 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)

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.

Suggested Citation

  • Klaus Kaier & Constantin Mühlen & Andreas Zirlik & Wolfgang Bothe & Philip Hehn & Manfred Zehender & Christoph Bode & Peter Stachon, 2019. "Estimating the additional costs per life saved due to transcatheter aortic valve replacement: a secondary data analysis of electronic health records in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(4), pages 625-632, June.
    • Handle: RePEc:spr:eujhec:v:20:y:2019:i:4:d:10.1007_s10198-018-1023-x
    DOI: 10.1007/s10198-018-1023-x
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10198-018-1023-x
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10198-018-1023-x?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Jonas Schreyögg & Oliver Tiemann & Reinhard Busse, 2006. "Cost accounting to determine prices: How well do prices reflect costs in the German DRG-system?," Health Care Management Science, Springer, vol. 9(3), pages 269-279, August.
    2. Kaier, K. & Reinecke, H. & Naci, Huseyin & Frankenstein, L. & Bode, M. & Vach, W. & Hehn, P. & Zirlik, A. & Zehender, M. & Reinöhl, J., 2017. "The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany," LSE Research Online Documents on Economics 69807, London School of Economics and Political Science, LSE Library.
    3. Matthias Vogl, 2012. "Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany," Health Economics Review, Springer, vol. 2(1), pages 1-12, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Klaus Kaier & Holger Reinecke & Huseyin Naci & Lutz Frankenstein & Martin Bode & Werner Vach & Philip Hehn & Andreas Zirlik & Manfred Zehender & Jochen Reinöhl, 2018. "The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(2), pages 223-228, March.
    2. Vogl, Matthias, 2014. "Hospital financing: Calculating inpatient capital costs in Germany with a comparative view on operating costs and the English costing scheme," Health Policy, Elsevier, vol. 115(2), pages 141-151.
    3. Christoph Baltin & Florian Kron & Alexander Urbanski & Thomas Zander & Anna Kron & Felix Berlth & Robert Kleinert & Michael Hallek & Arnulf Heinrich Hoelscher & Seung-Hun Chon, 2019. "The economic burden of endoscopic treatment for anastomotic leaks following oncological Ivor Lewis esophagectomy," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-12, August.
    4. Rieka von der Warth & Philip Hehn & Jan Wolff & Klaus Kaier, 2020. "Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study," Health Economics Review, Springer, vol. 10(1), pages 1-8, December.
    5. Robert Messerle & Jonas Schreyögg, 2024. "Country-level effects of diagnosis-related groups: evidence from Germany’s comprehensive reform of hospital payments," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(6), pages 1013-1030, August.
    6. Wozny, Florian, 2020. "Hospital Resources: Persistent Reallocation under Price Changes," IZA Discussion Papers 13256, Institute of Labor Economics (IZA).
    7. Mareike Heimeshoff & Jonas Schreyögg & Oliver Tiemann, 2014. "Employment effects of hospital privatization in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(7), pages 747-757, September.
    8. Bernhard Ultsch & Ingrid Köster & Thomas Reinhold & Anette Siedler & Gérard Krause & Andrea Icks & Ingrid Schubert & Ole Wichmann, 2013. "Epidemiology and cost of herpes zoster and postherpetic neuralgia in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 1015-1026, December.
    9. Gartner, Daniel & Kolisch, Rainer, 2014. "Scheduling the hospital-wide flow of elective patients," European Journal of Operational Research, Elsevier, vol. 233(3), pages 689-699.
    10. Lukas Kwietniewski & Jonas Schreyögg, 2018. "Efficiency of physician specialist groups," Health Care Management Science, Springer, vol. 21(3), pages 409-425, September.
    11. repec:mea:meawpa:13272 is not listed on IDEAS
    12. Raulinajtys-Grzybek, Monika, 2014. "Cost accounting models used for price-setting of health services: An international review," Health Policy, Elsevier, vol. 118(3), pages 341-353.
    13. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    14. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    15. Sutherland, Jason Murray & Walker, Jan, 2008. "Challenges of rehabilitation case mix measurement in Ontario hospitals," Health Policy, Elsevier, vol. 85(3), pages 336-348, March.
    16. Jonas Schreyögg & Tom Stargardt & Oliver Tiemann & Reinhard Busse, 2006. "Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries," Health Care Management Science, Springer, vol. 9(3), pages 215-223, August.
    17. Fainman, Emily Zhu & Kucukyazici, Beste, 2020. "Design of financial incentives and payment schemes in healthcare systems: A review," Socio-Economic Planning Sciences, Elsevier, vol. 72(C).
    18. Jürges, Hendrik & Köberlein, Juliane, 2015. "What explains DRG upcoding in neonatology? The roles of financial incentives and infant health," Journal of Health Economics, Elsevier, vol. 43(C), pages 13-26.
    19. Petrou, Panagiotis, 2021. "The 2019 introduction of the new National Healthcare System in Cyprus," Health Policy, Elsevier, vol. 125(3), pages 284-289.
    20. Mareike Heimeshoff & Helge Hollmeyer & Jonas Schreyögg & Oliver Tiemann & Doris Staab, 2012. "Cost of Illness of Cystic Fibrosis in Germany," PharmacoEconomics, Springer, vol. 30(9), pages 763-777, September.
    21. Vogl, Matthias, 2013. "Improving patient-level costing in the English and the German ‘DRG’ system," Health Policy, Elsevier, vol. 109(3), pages 290-300.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:eujhec:v:20:y:2019:i:4:d:10.1007_s10198-018-1023-x. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.