Outcomes, readmissions, and costs in transfemoral and alterative access transcatheter aortic valve replacement in the US Medicare population

McCarthy, Fenton H.; Spragan, Danielle; Savino, Danielle; Dibble, Taylor; Hoedt, Ashley; McDermott, Katherine M.; Bavaria, Joseph E.; Herrmann, Howard C.; Anwaruddin, Saif; Giri, Jay; Szeto, Wilson Y.; Groeneveld, Peter W.; Desai, Nimesh D.

doi:10.1016/j.jtcvs.2017.04.090

Cited by 30 publications

(17 citation statements)

References 31 publications

(49 reference statements)

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“…It also supports the fact that Medicare reimbursement is often used as a proxy for health sector costs under the assumption that Medicare reimbursement is set at a level such that providers make minimal long-run economic profit (26). For future research, a costcenter–specific CCR is recommended to estimate costs of inpatient care more accurately (25).…”

Section: Discussionmentioning

confidence: 99%

Reimbursement, Utilization, and 1-Year Survival Post-Allogeneic Transplantation for Medicare Beneficiaries With Acute Myeloid Leukemia

Mau

Meyer

Burns

et al. 2019

JNCI Cancer Spectrum

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BackgroundThe economics of allogeneic hematopoietic cell transplantation (alloHCT) for older patients with acute myeloid leukemia (AML) affects clinical practice and public policy. To assess reimbursement, utilization, and overall survival (OS) up to 1 year post-alloHCT for Medicare beneficiaries aged 65 years or older with AML, a unique merged dataset of Medicare claims and national alloHCT registry data was analyzed.MethodsPatients diagnosed with AML undergoing alloHCT from 2010 to 2011 were included for a retrospective cohort analysis with generalized linear model adjustment. One-year post-alloHCT reimbursement included Medicare, secondary payer, and beneficiary copayments (no coinsurance) (inflation adjusted to 2017 dollars). Cost-to-charge ratios were applied to estimate department-specific inpatient costs. Cox proportional hazards regression models were utilized to identify risk factors of 1-year OS post-alloHCT.ResultsA total of 250 patients met inclusion criteria. Mean total reimbursement was $230 815 (95% confidence interval [CI] = $214 381 to $247 249) 1 year after alloHCT. Pharmacy was the most- costly inpatient service category. Adjusted mean total reimbursement was statistically higher for patients who received cord blood grafts (P = .01), myeloablative conditioning (P < .0001), and alloHCT in the Northeast and West (P = .03). Mortality increased with age (hazard ratio [HR] = 1.08, 95% CI = 1.0 to 1.17), poorer Karnofsky performance score (<90% vs ≥90%, HR = 1.60, 95% CI = 1.08 to 2.35), and receipt of myeloablative conditioning (HR = 1.88, 95% CI = 1.21 to 2.92).ConclusionsThis merged dataset allowed adjustment for a richer set of patient- and HCT-related characteristics than claims data alone. The finding that nonmyeloablative conditioning was associated with lower reimbursement and improved OS 1 year post-alloHCT warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Reimbursement, Utilization, and 1-Year Survival Post-Allogeneic Transplantation for Medicare Beneficiaries With Acute Myeloid Leukemia

Mau

Meyer

Burns

et al. 2019

JNCI Cancer Spectrum

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“…It is difficult to compare TF-TAVI with TAo-TAVI because the latter group is ineligible for femoral access. It is possible that such a study might favor the TAo-TAVI technique even in TF patients, 3 as recently reported. 9 Alternatively, TAo-TAVI patients who are ineligible for TF-TAVI can be evaluated against the outcomes of surgical aortic valve replacement.…”

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confidence: 81%

“…1 The transapical approach, the initial technique described for TAVI, has declined in use compared with the transfermoral (TF) approach and newer, alternative routes. This may be attributed to the emergence of downsized delivery systems and to the more relevant role of the alternative routes (eg, axillary artery, carotid artery, and direct aortic approaches), 2,3 during the past decade.…”

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confidence: 99%

Commentary: Transaortic transcatheter aortic valve implantation: A route to be protected and not neglected

Formica

Singh

D’Alessandro

2019

The Journal of Thoracic and Cardiovascular Surgery

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“…14, 16-18 Because such prospective payments are based on average resource use this leads to loss of cost variability and precision across patients. 17-20 In some instances, patient level claims data are used, which capture both resource use and associated charges, 13-16, 21 however, such charges need to be converted to costs (i.e., the actual value of the resources consumed), which can be accomplished using institution specific cost-to-charge ratios (obtainable from CMS hospital cost reports). 13-16, 21-23 When charges are available at a cost center or department level (e.g.…”

Section: Estimation Of Costsmentioning

confidence: 99%

Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies

Ferket

Oxman

Iribarne

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Cost-effectiveness analysis (CEA) in cardiac surgery continues to grow in relevance with increasing health care expenditures, a greater emphasis on value-based care, the continuing development of costly surgical and noninvasive technologies, advances in cardiac devices, and changes in eligibility criteria over the past two decades. Although the rapidly evolving surgical technologies pose challenges to CEA, improvements in gathering and leveraging long-term economic and clinical data alongside trials and in cardiac surgery registries represent future opportunities for the field. As such, it is important for cardiac surgeons to understand CEA with respect to existing and future surgical therapies. Herein, we review the fundamental principles of cost-effectiveness analysis theory and discuss recent cost-effectiveness studies on cardiac surgery.

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Outcomes, readmissions, and costs in transfemoral and alterative access transcatheter aortic valve replacement in the US Medicare population

Abstract: For patients ineligible to receive TF TAVR, TAO and TA approaches offer similar clinical outcomes at similar cost with acceptable operative and 1-year survival, except for higher rates of CPB use in TA patients. CPB was associated with worse survival and increased costs.

Cited by 30 publications

References 31 publications

Reimbursement, Utilization, and 1-Year Survival Post-Allogeneic Transplantation for Medicare Beneficiaries With Acute Myeloid Leukemia

Reimbursement, Utilization, and 1-Year Survival Post-Allogeneic Transplantation for Medicare Beneficiaries With Acute Myeloid Leukemia

Commentary: Transaortic transcatheter aortic valve implantation: A route to be protected and not neglected

Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies

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