Costs for surgical aortic valve replacement according to preoperative risk categories

The introduction of transcatheter aortic valve replacement (TAVR) led to more rigorous evaluation of surgical aortic valve replacement (SAVR) as a benchmark for TAVR. However, limited real-life cost data of SAVR are available. Therefore, the purpose of our study was to assess actual costs and resource utilization of SAVR in patients at different operating risk.

Study data were drawn from a multi-institutional statewide database comprised of all cardiac surgical procedures in the Commonwealth of Virginia. The study included 2,530 elective, primary, isolated SAVRs performed from 2003 to 2012. Clinical data were matched with universal billing data. Patients were stratified into low-, intermediate- and high-risk categories according to the Society of Thoracic Surgeons- Predicted Risk of Mortality (STS-PROM) score: 0% to 4%, 4% to 8% , and greater than 8%, respectively. Clinical outcomes, resource use, and costs were compared between categories.

With increasing risk, there were higher rates of postoperative mortality (low 1.2% versus intermediate 2.7% versus high 6.2%, p < 0.001) and renal failure (2.7% vs 7.2% vs 10.6%; p < 0.001). The proportion of patients with any postoperative complication was higher with increasing risk (34% vs 48% vs 53%; p < 0.001). Length-of-stay increased from 6.8 days in the low-risk category to 10.2 and 11.3 days in the intermediate- and high-risk category, respectively (p < 0.001). There was an increase in mean total costs from the low- (n = 2,002) to intermediate- (n = 415) to high-risk (n = 113) category ($35,021 ± $22,642 vs $46,101 ± $42,460 vs $51,145 ± $31,655; p < 0.001).

Higher STS-PROM was significantly associated with higher postoperative mortality, complications, length-of-stay, and costs. The SAVR cost data provide a basis for the analysis of TAVR cost-effectiveness and its impact on payment systems.