Objective: To assess the in-hospital costs of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in the treatment of severe aortic stenosis. Methods: Patients treated with TAVR and SAVR in Shanghai Zhongshan Hospital from 2015 to 2019 were retrospectively collected, according to demography and baseline characteristics of the disease, propensity score matching (PSM) was used to control for baseline bias factors. The total hospitalization expenses, cost structure and per capita hospitalization days of the two groups were compared and analyzed. Results: A total of 285 cases (92 cases of TAVR and 193 cases of SAVR) were collected. After PSM, 30 cases of TAVR and 30 cases of SAVR were obtained. The results showed that the average total hospitalization cost of AS patients undergoing TAVR or SAVR for the first time was 284,476 yuan and 153,772 yuan, respectively, of which consumables cost accounted for 90.2% and 57.2%, respectively. The total hospitalization cost and consumables cost showed statistical differences between the two groups. In terms of hospitalization days, TAVR and SAVR were 9.3 and 15.0 days, respectively, with statistical differences. Conclusion: Compared with SAVR, TAVR can significantly reduce the length of hospital stay in the treatment of severe aortic stenosis. However, the total in-hospital costs of TAVR is significantly higher than SAVR, which leads to a heavy economic burden. Thus, we should pay attention to the clinical application and promotion of TAVR.
Key words
Transcatheter aortic valve replacement /
Surgical aortic valve replacement /
in-hospital costs
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Michail M, Davies JE, Cameron JD, et al.Pathophysiological coronary and microcirculatory flow alterations in aortic stenosis[J]. Nat Rev Cardiol, 2018, 15(7): 420-431.
[2] Thaden JJ, Nkomo VT, Enriquez-Sarano M.The global burden of aortic stenosis. Prog Cardiovasc Dis. 2014,56(6):565-571.
[3] 颜秋文,邵国丰.经导管主动脉瓣置换术在主动脉瓣狭窄治疗中的新进展[J].浙江医学,2020,42(23):2594-2598.
[4] Cribier A, Eltchaninoff H, Bash A, et al.Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis:first human case description. Circulation,2002,106(24): 3006-3008.
[5] 葛均波, 周达新, 潘文志等. 经皮主动脉瓣置入术一例报道附操作要点. 中国介入心脏病杂志,2010,18(5):243-246.
[6] 刘展,潘莹丽,涂朝凤等.基于倾向得分的伪权数构造与混合样本推断[J].统计与决策,2021,37(02):20-24.
[7] 周达新,潘文志,吴永健等.经导管主动脉瓣置换术中国专家共识(2020更新版)[J].中国介入心脏病学杂志,2020,28(06):301-309.
[8] 潘文志,龙愉良,周达新等.2020年经导管瓣膜治疗主要进展[J].中国胸心血管外科临床杂志,2021,28(04):371-375.
[9] Osnabrugge RL, Head SJ, Genders TS, et al.Costs of transcatheter versus surgical aortic valve replacement in intermediate-risk patients. Ann Thorac Surg. 2012,94(6):1954-60.
[10] Onohara T, Yoshikawa Y, Watanabe T, et al. Cost analysis of transcatheter versus surgical aortic valve replacement in octogenarians: analysis from a single Japanese center. Heart Vessels.2021 Mar 12.
[11] 陈英耀,刘文彬,唐檬等.我国卫生技术评估与决策转化研究概述[J].中国卫生政策研究, 2013,6(7):1-6.
[12] 明坚, 魏艳, 何运臻等. 医疗器械和诊断产品的卫生技术评估路在何方——基于国际经验的启示[J].中国医疗保险,2021(06):69-74.
[13] 国家医疗保障局,关于《基本医疗保险医用耗材支付管理暂行办法(征求意见稿)》 《医保医用耗材“医保通用名”命名规范(征求意见稿)》 公开征求意见的公告,[EB/OL].(2021-11-19) (2021-11-23) http://www.nhsa.gov.cn/art/2021/11/19/art_113_7352.html.
[14] 国家药品监督管理局,关于发布真实世界数据用于医疗器械临床评价技术指导原则(试行)的通告[EB/OL].(2020-11-16) (2021-12-10) https://www.nmpa.gov.cn/xxgk/ggtg/qtggtg/20201126090030150.html.
