Journal article
Transcatheter aortic valve replacement in Europe: adoption trends and factors influencing device utilization.
- Mylotte D Department of Interventional Cardiology at McGill University Health Centre, Montreal, Quebec, Canada; Galway University Hospital, Galway, Ireland.
- Osnabrugge RLJ Erasmus University Medical Center, Rotterdam, the Netherlands.
- Windecker S Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Lefèvre T Institut Cardiovasculaire Paris Sud, Massy, France.
- de Jaegere P Erasmus University Medical Center, Rotterdam, the Netherlands.
- Jeger R University Hospital Basel, Basel, Switzerland.
- Wenaweser P Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Maisano F Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy.
- Moat N Royal Brompton Hospital and on behalf of NICOR, London, United Kingdom.
- Søndergaard L Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
- Bosmans J Department of Cardiology, University Hospital Antwerp, Wilrijk, Belgium.
- Teles RC Hospital de Santa Cruz, Lisbon, and on behalf of VAP APIC-SPC, Portugal.
- Martucci G Department of Interventional Cardiology at McGill University Health Centre, Montreal, Quebec, Canada.
- Manoharan G Heart Centre, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom.
- Garcia E Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
- Van Mieghem NM Erasmus University Medical Center, Rotterdam, the Netherlands.
- Kappetein AP Erasmus University Medical Center, Rotterdam, the Netherlands.
- Serruys PW Erasmus University Medical Center, Rotterdam, the Netherlands.
- Lange R Department of Cardiovascular Surgery, German Heart Center, Munich, Germany.
- Piazza N Department of Interventional Cardiology at McGill University Health Centre, Montreal, Quebec, Canada; Department of Cardiovascular Surgery, German Heart Center, Munich, Germany. Electronic address: nicolopiazza@me.com.
- 2013-05-21
Published in:
- Journal of the American College of Cardiology. - 2013
Aortic Valve Stenosis
Cardiac Catheterization
Europe
Heart Valve Prosthesis Implantation
Humans
Registries
English
OBJECTIVES
The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy.
BACKGROUND
Since its commercialization in 2007, the number of TAVR procedures has grown exponentially.
METHODS
The adoption of TAVR was investigated in 11 European countries: Germany, France, Italy, United Kingdom, Spain, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. Furthermore, we assessed the extent to which TAVR has penetrated its potential patient population.
RESULTS
Between 2007 and 2011, 34,317 patients underwent TAVR. Considerable variation in TAVR use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 89). The weighted average TAVR penetration rate was low: 17.9%. Significant correlation was found between TAVR use and healthcare spending per capita (r = 0.80; p = 0.005). TAVR-specific reimbursement systems were associated with higher TAVR use than restricted systems (698 ± 232 vs. 213 ± 112 implants/million individuals ≥ 75 years; p = 0.002).
CONCLUSIONS
The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.
The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy.
BACKGROUND
Since its commercialization in 2007, the number of TAVR procedures has grown exponentially.
METHODS
The adoption of TAVR was investigated in 11 European countries: Germany, France, Italy, United Kingdom, Spain, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. Furthermore, we assessed the extent to which TAVR has penetrated its potential patient population.
RESULTS
Between 2007 and 2011, 34,317 patients underwent TAVR. Considerable variation in TAVR use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 89). The weighted average TAVR penetration rate was low: 17.9%. Significant correlation was found between TAVR use and healthcare spending per capita (r = 0.80; p = 0.005). TAVR-specific reimbursement systems were associated with higher TAVR use than restricted systems (698 ± 232 vs. 213 ± 112 implants/million individuals ≥ 75 years; p = 0.002).
CONCLUSIONS
The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jacc.2013.03.074
- PMID 23684674
- Persistent URL
- https://sonar.rero.ch/global/documents/144099
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