Pre- Versus Post-Procedure Health Care Resource Utilization in Patients Undergoing Commercial Transcatheter Mitral Valve Repair.
Pre- Versus Post-Procedure Health Care Resource Utilization in Patients Undergoing Commercial Transcatheter Mitral Valve Repair.
- 2019
BACKGROUND: TMVr is effective in degenerative mitral regurgitation (MR) and appropriately selected patients with functional MR with high surgical risk. CONCLUSIONS: TMVr is associated with a decrease in cardiovascular and HF hospitalizations and a greater likelihood of having no HF Medicare costs in the year after TMVr, regardless of MR etiology. Further work is necessary to elucidate the reasons for increased costs among patients with HF hospitalizations post-TMVr. Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: Patients undergoing TMVr in the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry from 2013 to 2018 were linked to Medicare claims data. Rates of hospitalizations, hospitalized days, and Medicare costs were compared 1 year pre-TMVr to 1 year post-TMVr. OBJECTIVES: The aim of this study was to assess the real-world impact of transcatheter mitral valve repair (TMVr) on hospitalizations and Medicare costs pre- versus post-TMVr. RESULTS: Across 246 sites, 4,970 patients with a median age of 83 years (interquartile range: 77 to 87 years) were analyzed. The TMVr indication was degenerative MR in 77.5% and functional MR in 16.7%. From pre- to post-TMVr, heart failure (HF) hospitalization rates (479 vs. 370 hospitalizations/1,000 person-years; rate ratio [RR]: 0.77) and cardiovascular hospitalizations (838 vs. 632; RR: 0.75) decreased significantly (p < 0.001 for all). Similarly, the rates of hospitalized days decreased for HF and cardiovascular causes (p < 0.05 for all). Following TMVr, the odds of having no Medicare costs for HF hospitalizations increased (69% vs. 79%; odds ratio: 1.67; p < 0.001). However, the average total Medicare costs per day alive among patients with any HF hospitalizations after TMVr increased significantly (p < 0.001). The HF hospitalization rates decreased for patients with functional MR (683 vs. 502; RR: 0.74) and those with degenerative MR (431 vs. 337; RR: 0.78) (p < 0.001).
English
1936-8798
10.1016/j.jcin.2019.09.056 [doi] S1936-8798(19)32102-8 [pii]
*Cardiac Catheterization/td [Trends]
*Health Resources/td [Trends]
*Heart Valve Prosthesis Implantation/td [Trends]
*Hospital Costs/td [Trends]
*Medicare/td [Trends]
*Mitral Valve Insufficiency/su [Surgery]
*Mitral Valve/su [Surgery]
*Patient Readmission/td [Trends]
Aged
Aged, 80 and over
Cardiac Catheterization/ae [Adverse Effects]
Cardiac Catheterization/ec [Economics]
Cost Savings
Cost-Benefit Analysis
Female
Health Resources/ec [Economics]
Heart Valve Prosthesis Implantation/ae [Adverse Effects]
Heart Valve Prosthesis Implantation/ec [Economics]
Humans
Male
Medicare/ec [Economics]
Mitral Valve Insufficiency/ec [Economics]
Patient Readmission/ec [Economics]
Registries
Time Factors
Treatment Outcome
United States
MedStar Heart & Vascular Institute
Journal Article
BACKGROUND: TMVr is effective in degenerative mitral regurgitation (MR) and appropriately selected patients with functional MR with high surgical risk. CONCLUSIONS: TMVr is associated with a decrease in cardiovascular and HF hospitalizations and a greater likelihood of having no HF Medicare costs in the year after TMVr, regardless of MR etiology. Further work is necessary to elucidate the reasons for increased costs among patients with HF hospitalizations post-TMVr. Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: Patients undergoing TMVr in the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry from 2013 to 2018 were linked to Medicare claims data. Rates of hospitalizations, hospitalized days, and Medicare costs were compared 1 year pre-TMVr to 1 year post-TMVr. OBJECTIVES: The aim of this study was to assess the real-world impact of transcatheter mitral valve repair (TMVr) on hospitalizations and Medicare costs pre- versus post-TMVr. RESULTS: Across 246 sites, 4,970 patients with a median age of 83 years (interquartile range: 77 to 87 years) were analyzed. The TMVr indication was degenerative MR in 77.5% and functional MR in 16.7%. From pre- to post-TMVr, heart failure (HF) hospitalization rates (479 vs. 370 hospitalizations/1,000 person-years; rate ratio [RR]: 0.77) and cardiovascular hospitalizations (838 vs. 632; RR: 0.75) decreased significantly (p < 0.001 for all). Similarly, the rates of hospitalized days decreased for HF and cardiovascular causes (p < 0.05 for all). Following TMVr, the odds of having no Medicare costs for HF hospitalizations increased (69% vs. 79%; odds ratio: 1.67; p < 0.001). However, the average total Medicare costs per day alive among patients with any HF hospitalizations after TMVr increased significantly (p < 0.001). The HF hospitalization rates decreased for patients with functional MR (683 vs. 502; RR: 0.74) and those with degenerative MR (431 vs. 337; RR: 0.78) (p < 0.001).
English
1936-8798
10.1016/j.jcin.2019.09.056 [doi] S1936-8798(19)32102-8 [pii]
*Cardiac Catheterization/td [Trends]
*Health Resources/td [Trends]
*Heart Valve Prosthesis Implantation/td [Trends]
*Hospital Costs/td [Trends]
*Medicare/td [Trends]
*Mitral Valve Insufficiency/su [Surgery]
*Mitral Valve/su [Surgery]
*Patient Readmission/td [Trends]
Aged
Aged, 80 and over
Cardiac Catheterization/ae [Adverse Effects]
Cardiac Catheterization/ec [Economics]
Cost Savings
Cost-Benefit Analysis
Female
Health Resources/ec [Economics]
Heart Valve Prosthesis Implantation/ae [Adverse Effects]
Heart Valve Prosthesis Implantation/ec [Economics]
Humans
Male
Medicare/ec [Economics]
Mitral Valve Insufficiency/ec [Economics]
Patient Readmission/ec [Economics]
Registries
Time Factors
Treatment Outcome
United States
MedStar Heart & Vascular Institute
Journal Article