Hospital Characteristics Associated with Observed Transcatheter Aortic Valve Replacement Prices

Transcatheter aortic valve replacement (TAVR) has emerged as a revolutionary treatment for aortic stenosis. However, TAVR prices vary considerably, and factors associated with this variation remain unclear. We aim to describe the variation in TAVR prices in relation to hospital financial performance among institutions ranked by the U.S. News and World Report (USNWR). Using a modified two-part model, we examined financial and operational characteristics (TAVR performance scores, median all-payer within-hospital TAVR price, net hospital profit margin, hospital markups [i.e., charge-to-cost ratio], bed days available, and CMS wage index) of 640 TAVR-performing hospitals ranked by the USNWR. After determining observed to expected (O:E) ratios for TAVR prices for each hospital, we then examined hospital characteristics across O:E quintiles. Overall, price disclosure was 48.6% (n=311). Between the lowest and highest O:E quintiles, median hospital markup (4.75 vs 5.33; p=0.41) and median net hospital margin (1.76 vs 3.15; p=0.12) were comparable. The highest O:E ratio quintile had lower median TAVR prices compared to the lowest O:E ratio quintile ($72,129.12 vs $49,022.03; p<0.001). Most significantly, TAVR price IQR's within hospitals had a linear decline from the lowest to the highest O:E ratio quintiles ($119,043 vs $27,240; p<0.001). USNWR ranking scores had no significant variation across the quintiles (p=0.95). We concluded that hospitals that charge more than expected for TAVRs do not have higher profit margins nor markups and are not higher ranked by USNWR as those that charge less than expected. Additionally, with higher observed over expected TAVR prices, the variation in TAVR rates within hospitals decreased linearly. Finally, O:E TAVR price ratios appear to have no association with publicly reported hospital quality.