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While the cost of surgical aortic valve replacement (SAVR) is on its way down, transcatheter aortic valve replacement (TAVR) is getting more and more pricey, researchers found.

TAVR was 8.38% more expensive than surgery after multivariable adjustment (95% CI 5.98-10.84) but with no significant difference in mortality (adjusted OR 0.81, 95% CI 0.62-1.05) or neurologic complications (OR 0.90, 95% CI 0.55-1.47), Peyman Benharash, MD, of UCLA, and colleagues reported online JAMA Surgery.

Inpatient expenses from the surgery totaled $37,795 in the 2004-2010 period, rising slightly to $39,739 in 2011-2013 as patient comorbidity rose over time. But the annual cost of SAVR started falling in 2011 and by 2013 had . Over the decade, operators also improved on mortality rates (4% in 2004-2010 vs 3% in 2011-2013, OR 0.75, 95% CI 0.63-0.89).

The cost of TAVR, meanwhile, rose from $51,008 in 2011 -- when the Sapien device got the first FDA approval -- to $55,136 in 2013 (P<0.001). There were no changes in patient comorbidities or rates of postoperative complications over time in the data.

"The reduction in cost of SAVR and stabilization of disease severity reflect more efficient allocation of resources between SAVR and TAVR. However, the cost of TAVR is increasing. Previous analyses have recommended reductions in the initial cost of TAVR to ensure its cost-effectiveness in practice and implicated the higher fixed cost of the valve. Our data show that this discrepancy remains despite the development of new generations of valves and increased competition in transcatheter technology," according to Benharash's group.

"As the indication for TAVR expands to medium- and low-risk cohorts, legislation may be necessary to ensure its cost-effectiveness."

Benharash and colleagues performed a retrospective analysis of patients with severe aortic stenosis who got aortic valve replacement -- without a concomitant intervention or a redo -- and were included in the National Inpatient Sample's Healthcare Cost and Utilization Project. The group was separated into those who got early SAVR (N=101,1031), late SAVR (n=50,078), and TAVR (n=21,999).

Some of the cost differential may have to do with the learning curve for TAVR programs, the authors suggested.

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