Analysis of the additional costs of clinical complications in patients undergoing transcatheter aortic valve replacement in the German Health Care System

The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany

“…As shown in Table S1, the predicted reimbursement of an uncomplicated TAVI procedure was €33,272. In contrast, a previous study from our group calculated the predicted cost of an uncomplicated TF-TAVI procedure at €34,351, which would indicate reimbursement almost covering the cost of treatment for these patients [7]. This is perhaps unsurprising given the design of the German DRG system and its use of empirical data to validate and adjust the value on an annual basis.…”

“…As stated before, we used the available diagnostic and procedural codes for acute and chronic conditions (OPS and ICD-10-GM as discussed in greater detail in a previous paper [1,17]). Other studies were able to categorize complications according to the latest definitions by the valve academic research consortium (VARC-2) [7,23], which is far more detailed and makes our results not directly comparable for some dimensions. Third, the timing of post-procedural complications is not available from the dataset.…”

“…We previously identified life threatening non-access site bleeding (€47,494) and stage 3 Acute kidney injury (€20,468) as having the most substantial impact on hospital costs [7]. Moreover, the study results indicate that the additional costs of complications are predominantly found within the ICU costs, which is most likely attributable to the complexity of the case and the severity and timing of complications [7].…”

“…Comparisons of TAVR and SAVR have been less conclusive, possibly due at least in part to a lack of strong clinical data underpinning the analyses, since accurate published cost data for TAVR procedures is somewhat limited due to difficulties in collecting data from most systems [7].…”

“…For TAVR procedures performed in Germany, it has previously been shown that bleeding complications are associated with increased resource use and in-hospital costs in a real-life cohort of patients [8], and complication-induced additional costs of patients undergoing TAVR were analyzed in a prospective observational study of 163 consecutive cases [7]. This latest study uses statistical and costing data from the German universal healthcare system and the German Federal Statistical Office to further improve our understanding of the economics of clinical TAVR practice.…”