The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany
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The impact of various post-procedural complications after transcatheter aortic valve implantation (TAVI) on resource use and their consequences in the German reimbursement system has still not been properly quantified.
In a retrospective observational study, we use data from the German DRG statistic on patient characteristics and in-hospital outcomes of all isolated TAVI procedures in 2013 (N = 9147). The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation was analyzed using both unadjusted and risk-adjusted linear and logistic regression analyses.
A total of 235 (2.57%) strokes, 583 (6.37%) bleeding events, 474 (5.18%) cases of acute kidney injury and 1428 (15.61%) pacemaker implantations were documented. The predicted reimbursement of an uncomplicated TAVI procedure was €33,272, and bleeding events were associated with highest additional reimbursement (€12,839, p < 0.001), extra length of stay (14.58 days, p < 0.001), and increased likelihood of mechanical ventilation for more than 48 h (OR 17.91, p < 0.001). A more moderate complication-related impact on resource use and reimbursement was found for acute kidney injury (additional reimbursement: €5963, p < 0.001; extra length of stay: 7.92 days, p < 0.001; ventilation >48 h: OR 6.93, p < 0.001) as well as for stroke (additional reimbursement: €4125, p < 0.001; extra length of stay: 4.68 days, p < 0.001; ventilation >48 h: OR 5.73, p < 0.001). Pacemaker implantations, in contrast, were associated with comparably small increases in reimbursement (€662, p = 0.006) and length of stay (3.54 days, p = 0.006) and no impaired likelihood of mechanical ventilation more than 48 h (OR 1.22, p = 0.156). Interestingly, these complication-related consequences remain mostly unchanged after baseline risk-adjustment.
Post procedural complications such as bleeding events, acute kidney injuries and strokes are associated with increased resource use and substantial amounts of additional reimbursement in Germany, which has important implications for decision making outside of the usual clinical sphere.
KeywordsPost-procedural complications TAVR Transcatheter aortic valve replacement Excess costs Reimbursement Resource use
JEL ClassificationC01 I10
- 2.Gada, H., Agarwal, S., Marwick, T.H.: Perspective on the cost-effectiveness of transapical aortic valve implantation in high-risk patients: outcomes of a decision-analytic model. Ann. Cardiothorac. Surg. 2012(1), 145–155 (2012)Google Scholar
- 3.Orlando, R., Pennant, M., Rooney, S., Khogali, S., Bayliss, S., Hassan, A., Moore, D., Barton, P.: Cost-effectiveness of transcatheter aortic valve implantation (TAVI) for aortic stenosis in patients who are high risk or contraindicated for surgery: a model-based economic evaluation. Health Technol. Assess. 17, (2013)Google Scholar
- 4.Reynolds, M.R., Magnuson, E.A., Wang, K., Lei, Y., Vilain, K., Walczak, J., Kodali, S.K., Lasala, J.M., O’Neill, W.W., Davidson, C.J., Smith, C.R., Leon, M.B., Cohen, D.J., PARTNER Investigators: Cost-effectiveness of transcatheter aortic valve replacement compared with standard care among inoperable patients with severe aortic stenosis: results from the placement of aortic transcatheter valves (PARTNER) trial (Cohort B). Circulation 125, 1102–1109 (2012)CrossRefPubMedGoogle Scholar
- 7.Gutmann, A., Kaier, K., Sorg, S., von zur Mühlen, C., Siepe, M., Moser, M., Geibel, A., Zirlik, A., Ahrens, I., Baumbach, H.: Analysis of the additional costs of clinical complications in patients undergoing transcatheter aortic valve replacement in the German Health Care System. Int. J. Cardiol. 179, 231–237 (2015)Google Scholar
- 15.Malyar, N., Furstenberg, T., Wellmann, J., Meyborg, M., Luders, F., Gebauer, K., Bunzemeier, H., Roeder, N., Reinecke, H.: Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis. Eur. Heart J. 34, 2706–2714 (2013)CrossRefPubMedGoogle Scholar
- 17.Reinöhl, J., K. Kaier, Reinecke, H., Schmoor, C., Frankenstein, L., Vach, W., Cribier, A., Beyersdorf, F., Bode, C., Zehender, M.: Effect of availability of transcatheter aortic valve replacement on clinical practice: supplementary appendix. N. Engl. J. Med. 373, 2438–2447 (2015)Google Scholar
- 19.Heinz, J., Fiori, W., Heusser, P., Ostermann, T.: Cost analysis of integrative inpatient treatment based on DRG data: the example of anthroposophic medicine. Evid. Based Complement. Alternat, Med (2013)Google Scholar
- 20.Quentin, W., Geissler, A., Scheller-Kreinsen, D., Busse, R.: DRG-type hospital payment in Germany: the G-DRG system. Euro. Obs. 12, 4–6 (2010)Google Scholar
- 21.Braun, J.-P., Bause, H., Bloos, F., Geldner, G., Kastrup, M., Kuhlen, R., Markewitz, A., Martin, J., Mende, H., Quintel, M.: Peer reviewing critical care: a pragmatic approach to quality management. GMS Ger. Med. Sci. 8, (2010)Google Scholar
- 22.Cao, C., Liou, K., Pathan, F., Virk, S., McMonnies, R., Wolfenden, H., Indraratna, P.: Transcatheter aortic valve implantation versus surgical aortic valve replacement: meta-analysis of clinical outcomes and cost-effectiveness. Curr. Pharm, Des (2016)Google Scholar
- 23.Kappetein, A.P., Head, S.J., Généreux, P., Piazza, N., Van Mieghem, N.M., Blackstone, E.H., Brott, T.G., Cohen, D.J., Cutlip, D.E., van Es, G.-A.: Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J. Am. Coll. Cardiol. 60, 1438–1454 (2012)CrossRefPubMedGoogle Scholar