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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
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    References listed on IDEAS

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    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.
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