Housing instability factors into cost of care after TAVR
Key takeaways:
- Family or housing instability was associated with increased cost of care after TAVR.
- After adjustment for clinical/demographic variables, neither material deprivation nor ethnic concentration affected TAVR cost.
Residential instability, a component of neighborhood social deprivation included in the Ontario Marginalization Index, was associated with increased health care costs after transcatheter aortic valve replacement, researchers reported.
“With growing demand for TAVR, the costs of the procedure have been a topic of substantial investigation. The costs of TAVR vary in the preprocedural, procedural and postprocedural phases depending on both modifiable and nonmodifiable risk factors, which include patient comorbidities, procedural complications and urgency of referrals,” Hasrit Sidhu, BSc, MD, internal medicine resident at the Schulich Heart Program, Sunnybrook Health Sciences Centre, and the Temerty Faculty of Medicine at the University of Toronto, and colleagues wrote. “It is imperative to understand the relationship between TAVR-related healthcare costs and the ... dimensions of marginalization.”
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The study was published in Circulation: Cardiovascular Quality and Outcomes.
Sidhu and colleagues utilized the Ontario Marginalization Index and the CorHealth Ontario TAVR registry to evaluate the relationship between TAVR cost and the three dimensions of marginalization: material deprivation, residential instability and ethnic concentration.
In Ontario, residents receive universal health care from the Ministry of Health, and TAVR has been funded since 2012.
Between 2017 and 2020, a total of 3,784 patients underwent TAVR (mean age, 81 years; 43% women; 11.7% rural living).
Cumulative mean cost was $8,116 in the referral phase, $32,790 during the procedural phase and $18,901 during the postprocedural phase.
After adjustment for clinical and demographic variables, increased residential instability — defined as area-level concentrations of people with elevated rates of family and/or housing instability — was associated with greater cumulative costs after TAVR, with a cost ratio of 1.11 (95% CI, 1.05-1.16).
Neither material deprivation nor ethnic concentration were associated with any significantly elevated cost during the referral, procedural and postprocedural phases of TAVR.
“There is a paucity of studies that examine socioethnic factors such as material deprivation and residential instability, and their impact on TAVR costs, and whether this may differ in Canada, where universal health care exists. Theoretically, universal coverage should mitigate a proportion of this inequity,” the researchers wrote. “Although our study was not designed to understand the nature of this relationship between residential instability and TAVR costs, we can hypothesize several plausible explanations. Residential instability is related to neighborhood quality, cohesiveness and overall community support. It is defined by a few key indicators: (1) proportion of the population living alone, (2) proportion of the population that is single, (3) proportion of the population living in apartments/rental properties, (4) proportion of the population that has moved in the past 5 years.”
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