Costs of periprocedural complications in patients treated with transcatheter aortic valve replacement: results from the Placement of Aortic Transcatheter Valve trial

Circ Cardiovasc Interv. 2014 Dec;7(6):829-36. doi: 10.1161/CIRCINTERVENTIONS.114.001395. Epub 2014 Oct 21.


Background: In patients with severe aortic stenosis, transcatheter aortic valve replacement (TAVR) improves survival when compared with nonsurgical therapy but with higher in-hospital and lifetime costs. Complications associated with TAVR may decrease with greater experience and improved devices, thereby reducing the overall cost of the procedure. Therefore, we sought to estimate the effect of periprocedural complications on in-hospital costs and length of stay of TAVR.

Methods and results: Using detailed cost data from 406 TAVR patients enrolled in the Placement of Aortic Transcatheter Valve (PARTNER) I trial, we developed multivariable models to estimate the incremental cost and length of stay associated with specific periprocedural complications. Attributable costs and length of stay for each complication were calculated by multiplying the independent cost of each event by its frequency in the treatment group. Mean cost for the initial hospitalization was $79 619±40 570 ($50 891 excluding the valve); 49% of patients had ≥1 complication. Seven complications were independently associated with increased hospital costs, with major bleeding, arrhythmia, and death accounting for the largest attributable cost per patient. Renal failure and the need for repeat TAVR, although less frequent, were also associated with substantial incremental and attributable costs. Overall, complications accounted for $12 475 per patient in initial hospital costs and 2.4 days of hospitalization.

Conclusions: In the PARTNER trial, periprocedural complications were frequent, costly, and accounted for ≈25% of non-implant-related hospital costs. Avoidance of complications should improve the cost-effectiveness of TAVR for inoperable and high-risk patients, but reductions in the cost of uncomplicated TAVR will also be necessary for optimal efficiency.

Clinical trial registration url: Unique identifier: NCT00530894.

Keywords: aortic valve; complications; costs and cost analysis; transcatheter aortic valve replacement.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / economics*
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / therapy*
  • Cardiac Catheterization / adverse effects*
  • Cardiac Catheterization / economics*
  • Cardiac Catheterization / instrumentation
  • Cardiac Catheterization / mortality
  • Chi-Square Distribution
  • Comorbidity
  • Female
  • Heart Valve Prosthesis / economics
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Heart Valve Prosthesis Implantation / economics*
  • Heart Valve Prosthesis Implantation / instrumentation
  • Heart Valve Prosthesis Implantation / mortality
  • Hospital Costs*
  • Hospital Mortality
  • Hospitalization / economics*
  • Humans
  • Length of Stay / economics
  • Linear Models
  • Logistic Models
  • Male
  • Models, Economic
  • Multivariate Analysis
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • United States

Associated data