Cost burden of transcatheter edge-to-edge mitral valve repair declining
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The 30‐day cost burden of transcatheter edge-to-edge mitral valve repair has declined since 2014 due to a shorter index length of stay; however, CV readmissions and readmission costs have remained steady, researchers reported.
From 2014 to 2018, the average length of stay after transcatheter edge-to-edge repair (TEER) in the U.S. has declined from 7 days to 5 days, whereas the average cost of the index hospitalization during that time decreased by about $1,300 per year, according to John P. Vavalle, MD, MHS, FACC, assistant professor of medicine and medical director of the Structural Heart Disease Program at the University of North Carolina, Chapel Hill, and colleagues. Yet, an analysis of nationwide data show readmission rates after TEER have not declined during that same time.
‘We seem to have gotten better’
“As proceduralists, we seem to have gotten better with TEER and probably also better at patient selection,” Vavalle told Healio. “This has led to reduced lengths of stay after TEER and reduced costs of the index hospitalization; however, readmission rates have remained unchanged. We need to identify ways to reduce the readmission rates after TEER — specifically, HF readmission rates remain high. It will take a heart team approach to identify the most appropriate patients who benefit from TEER and to ensure that they are also receiving maximal medical therapy for HF.”
Vavalle and colleagues assessed patient characteristics, cause‐specific readmission, and costs of the index hospitalization and readmissions for 10,196 adults who underwent mitral TEER in the U.S. from 2014 to 2018, using the Nationwide Readmission Database. Costs were trended over years using general linear regression analysis.
The findings were published in Catheterization and Cardiovascular Interventions.
Within the cohort, 30-day readmissions were stable over time, at about 16%. Of the readmissions, 49% were for a primary CV cause. The median age at the time of procedure modestly increased with time, from age 78 years in 2014 to age 81 years in 2018. The mean length of stay following TEER decreased from 7 days in 2014 to 5 days in 2018.
Index hospitalization costs down
Researchers observed a mean decline in the cost of the index hospitalization of $1,311 per year, as well as a decline in the total 30‐day cost of $1,588 per year (P < .001), both attributed to a reduction in the cost of the index hospitalization without a change in readmission costs over time (P = .23).
“Even though cardiovascular causes accounted for slightly less than half of the readmissions, they were responsible for the majority of the health care costs and were on average about $10,000 more expensive than noncardiovascular readmissions,” the researchers wrote.
Infectious causes of readmissions decreased, whereas total CV readmissions, including HF, remained constant.
“We need to better understand the reasons for readmission after TEER and identify those risk factors that place patients at highest risk for readmission,” Vavalle told Healio. “I am especially concerned about the high rates of readmission for HF. Does this reflect that we are not always selecting patients who can benefit from this therapy? Do we need to work more closely with our advanced HF colleagues to ensure that MitraClip [Abbott] is used as one tool of many that are in our armamentarium for the treatment of HF?”
For more information:
John P. Vavalle, MD, MHS, FACC, can be reached at john_vavalle@med.unc.edu.
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