ORCID ID

0000-0003-2952-7837

Graduation Date

Spring 5-9-2020

Document Type

Thesis

Degree Name

Master of Science (MS)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Brian D. Lowes

Second Advisor

Ted R. Mikuls

Third Advisor

Kaleb Michaud

Fourth Advisor

Douglas A. Stoller

Abstract

Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding usage and cost of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease. From the Nationwide Readmissions Database, we determined utilization and cost trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted 2012-2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. From 2012 through 2016, there was a 48.1% increase in the number of patients hospitalized for aortic valve disease annually. Overall, 19.9%, 6.7%, and 73.4% of patients received SAVR, TAVR, and MT, respectively. SAVR decreased from 21.9% in 2012 to 18.5% in 2016; TAVR increased from 2.6% to 12.5%; and MT decreased from 75.5% to 69.0%. In multivariable analysis, likelihood of TAVR relative to SAVR increased 4.57-fold (95% confidence interval 4.21-4.97) with TAVR increasing at the expense of both SAVR and MT. The average 6-month inpatient costs were $59,743 for SAVR, $64,395 for TAVR, and $23,460 for MT. TAVR IA costs decreased over time to become similar to SAVR costs by 2016. The TAVR increase was distributed inequitably, with certain patients more likely to receive TAVR and certain hospitals more likely to provide TAVR. Aggregate costs were higher for TAVR than SAVR and were significantly more expensive than MT alone. With the expected expansion of indications, equitable and affordable access to TAVR must be addressed to minimize disparities and to optimize patient outcomes.

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