Innovative technology-transcatheter aortic valve implantation: Cost and reimbursement issues

Figures & data

Table I. Patient demographics.

	TA (n = 25)	TF (n = 25)	All (n = 50)
Age years (mean)	80	81	81
Male/Female (n)	16/9	15/10	31/19
Logistic EURO score (mean)	34	31	33
NYHA class	3	3	3
EF % (mean)	42	45	44
Permanent pacemaker (n)	3	4	7
Atrial fibrillation (n)	12	6	18
Redo procedure (n)	17	12	29
PCI prior to procedure (n)	6	3	9
Area cm² (mean)	0.6	0.6	0.6
Mean gradient mmHg (mean)	51	57	54
Annulus size mm (mean)	22	23	23

Figure 1. Comparison of the total hospital cost and 100% DRG reimbursement. The DRG reimbursement is a fixed cost and is the same for all patients.

Table II. Results.

	TA (n = 25)	TF (n = 25)	All (n = 50)
Successful implantation (n)	25	24	49
External chest compression (n)	8	3	11
Partial bypass (n)	3^1	2^2	5
IABP postoperative (n)	2	2	4
CoreValve^® (n)	0	8	8
Prosthesis used, diameter mm (mean)	25	26	25
New pacemaker (n)	0	1	1
Stroke (minor/major) (n)	2/2	1/0	3/2
Myocardial infarction (n)	1	0	1
Revision in the groin (n)	1	1	2
Pericardiocentesis (n)	0	2	2
Hemothorax (n)	2	0	2
Procedure related mortality (but not during procedure)	1	1	2^3
In hospital mortality (30 days)	6	1	7
Total mortality^4	8	3	11

¹mean time 52 minutes.

²mean time 63 minutes.

³one due to myocardial infarction (not occlusion of the coronary) one due to ventricular perforation.

⁴observation time 4–26 months.

Figure 3. The correlation between the number of procedures and the cost. There is a slight negative slope in costs with the increasing number of procedures performed.

Table III. Average Procedure cost and DRG reimbursement (mean) (US$).

	TA (n = 25)	TF (n = 25)
Total hospital cost mean (range)	55,690 (44,552–69,505)	52,087 (39,925–69,422)
DRG reimbursement (100%) 2010	39,555	39,555
Device cost (%)	52%	55%
Operation room cost (%)	8%	11%
LOS cost (%)	34%	33%
Other cost (%)	6%	1%
Procedure time in operating room (hours)	4	3,5
Total length of stay in hospital (hours)	199	170

Figure 4. The total cost fragmentations and analysis of the cost drivers. The device cost is fixed so the major difference is because of different LOS (length of stay).

Figure 2. Accumulated clinical pathway for each patient. Information of LOS in hours at different clinical department levels. Zero is the time of the procedure. On the left: elapsed time prior to TAVI. On the right: elapsed time following TAVI. HMOV, Cardiological intensive care unit; HMSP, Cardiological unit; IVS, Intervention Center; PO, Post operative care unit; TKAI, Cardiothoracic intensive care unit; TKop, Cardiothoracic Operating room; TKASP, Cardiothoracic general unit.