Comparison of Causes and Associated Costs of 30-Day Readmission of Transcatheter Implantation Versus Surgical Aortic Valve Replacement in the United States (A National Readmission DatabaseStudy)

Avnish Tripathi, Michael P. Flaherty, J. Dawn Abbott, Gregg C. Fonarow, Abdur R. Khan, Arti Saraswat, Harleen Chahil, Dhaval Kolte, Sammy Elmariah, Glenn A. Hirsch, Verghese Mathew, Ajay J. Kirtane, Deepak L. Bhatt

Research output: Contribution to journal › Article

5 Citations (Scopus)

Abstract

Our current knowledge about comparative differences in 30-day readmissions and the impact of readmissions on overall costs after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) is largely derived from clinical trials. The objectives of this study were to compare readmissions and costs for TAVI and SAVR in a nationally representative population-based sample. The Healthcare Cost and Utilization Project's National Readmission Database was used for the study. Hierarchical multivariable regression analyses were used to examine differences in the propensity score 1:1 matched cohort. The matched cohort included 4,682 patients who survived index procedures done from January through November 2013. Compared with SAVR, the rate of 30-day readmission was not significantly different for endovascular TAVI (16% vs 18%; p = 0.19); and was higher for the transapical TAVI (22% vs 17%; p <0.01) group. The 30-day cumulative costs were higher for the 2 endovascular TAVI ($51,025 vs $46,228; p = 0.03) and transapical TAVI ($59,575 vs $45,792; p <0.01). In multivariable analyses, the risk of 30-day readmission was similar for endovascular TAVI (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.78 to 1.12) and was 27% higher for transapical TAVI (OR 1.27; 95% CI 1.02 to 1.57). Cumulative costs (index plus readmission costs) were 13% (β 0.13; 95% CI 0.10 to 0.15) and 19% (β 0.19; 95% CI 0.16 to 0.23) higher for the endovascular TAVI and transapical TAVI, respectively. In conclusion, the rate of readmissions was similar for endovascular TAVI and SAVR but the costs were 26% higher for TAVI than for SAVR.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

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Aortic Valve
Surgical Instruments
Costs and Cost Analysis
Confidence Intervals
Transcatheter Aortic Valve Replacement
Odds Ratio
Propensity Score
Health Care Costs
Regression Analysis
Clinical Trials
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of Causes and Associated Costs of 30-Day Readmission of Transcatheter Implantation Versus Surgical Aortic Valve Replacement in the United States (A National Readmission DatabaseStudy). / Tripathi, Avnish; Flaherty, Michael P.; Abbott, J. Dawn; Fonarow, Gregg C.; Khan, Abdur R.; Saraswat, Arti; Chahil, Harleen; Kolte, Dhaval; Elmariah, Sammy; Hirsch, Glenn A.; Mathew, Verghese; Kirtane, Ajay J.; Bhatt, Deepak L.

In: American Journal of Cardiology, 01.01.2018.

Research output: Contribution to journal › Article

Tripathi, A, Flaherty, MP, Abbott, JD, Fonarow, GC, Khan, AR, Saraswat, A, Chahil, H, Kolte, D, Elmariah, S, Hirsch, GA, Mathew, V, Kirtane, AJ & Bhatt, DL 2018, 'Comparison of Causes and Associated Costs of 30-Day Readmission of Transcatheter Implantation Versus Surgical Aortic Valve Replacement in the United States (A National Readmission DatabaseStudy)', American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2018.04.024
Tripathi A, Flaherty MP, Abbott JD, Fonarow GC, Khan AR, Saraswat A et al. Comparison of Causes and Associated Costs of 30-Day Readmission of Transcatheter Implantation Versus Surgical Aortic Valve Replacement in the United States (A National Readmission DatabaseStudy). American Journal of Cardiology. 2018 Jan 1. https://doi.org/10.1016/j.amjcard.2018.04.024
Tripathi, Avnish ; Flaherty, Michael P. ; Abbott, J. Dawn ; Fonarow, Gregg C. ; Khan, Abdur R. ; Saraswat, Arti ; Chahil, Harleen ; Kolte, Dhaval ; Elmariah, Sammy ; Hirsch, Glenn A. ; Mathew, Verghese ; Kirtane, Ajay J. ; Bhatt, Deepak L. / Comparison of Causes and Associated Costs of 30-Day Readmission of Transcatheter Implantation Versus Surgical Aortic Valve Replacement in the United States (A National Readmission DatabaseStudy). In: American Journal of Cardiology. 2018.
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abstract = "Our current knowledge about comparative differences in 30-day readmissions and the impact of readmissions on overall costs after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) is largely derived from clinical trials. The objectives of this study were to compare readmissions and costs for TAVI and SAVR in a nationally representative population-based sample. The Healthcare Cost and Utilization Project's National Readmission Database was used for the study. Hierarchical multivariable regression analyses were used to examine differences in the propensity score 1:1 matched cohort. The matched cohort included 4,682 patients who survived index procedures done from January through November 2013. Compared with SAVR, the rate of 30-day readmission was not significantly different for endovascular TAVI (16{\%} vs 18{\%}; p = 0.19); and was higher for the transapical TAVI (22{\%} vs 17{\%}; p <0.01) group. The 30-day cumulative costs were higher for the 2 endovascular TAVI ($51,025 vs $46,228; p = 0.03) and transapical TAVI ($59,575 vs $45,792; p <0.01). In multivariable analyses, the risk of 30-day readmission was similar for endovascular TAVI (odds ratio [OR] 0.93; 95{\%} confidence interval [CI] 0.78 to 1.12) and was 27{\%} higher for transapical TAVI (OR 1.27; 95{\%} CI 1.02 to 1.57). Cumulative costs (index plus readmission costs) were 13{\%} (β 0.13; 95{\%} CI 0.10 to 0.15) and 19{\%} (β 0.19; 95{\%} CI 0.16 to 0.23) higher for the endovascular TAVI and transapical TAVI, respectively. In conclusion, the rate of readmissions was similar for endovascular TAVI and SAVR but the costs were 26{\%} higher for TAVI than for SAVR.",
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AU - Flaherty, Michael P.

AU - Abbott, J. Dawn

AU - Fonarow, Gregg C.

AU - Khan, Abdur R.

AU - Saraswat, Arti

AU - Chahil, Harleen

AU - Kolte, Dhaval

AU - Elmariah, Sammy

AU - Hirsch, Glenn A.

AU - Mathew, Verghese

AU - Kirtane, Ajay J.

AU - Bhatt, Deepak L.

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