Abstract 4145176: Prices for Transcatheter Aortic Valve Repair Vary Significantly by US Insurance Company

Background: Transcatheter aortic valve replacement (TAVR) is a crucial procedure for managing aortic stenosis (AS). Despite its widespread adoption, substantial price differences exist between hospitals and insurance companies. This study aims to analyze these variations across major insurers using new pricing data. Hypothesis: We hypothesize significant variation in TAVR prices across insurance plans, influenced by plan type and hospital characteristics. Methods: TAVR prices for Diagnosis Related Group (DRG) code 267 (TAVR without major cardiac complications) were analyzed using the Turquoise Health database. Prices from Aetna, Blue Cross Blue Shield, Cigna, Humana, Medicare, and United Healthcare were compared across HMO/Managed Care, Medicare Advantage, Medicaid, and Other plan types. Outliers beyond the 95th and below the 5th percentiles were excluded. Results: The median commercial price for TAVR was $71,312, about 1.88 times the Medicare rate. In comparison, the median cash price was $78,000. List prices were the highest, with a median of $166,714 and a substantial standard deviation of $83,534. Price variation between hospitals (2.6 times) was greater than within hospitals (2.0 times). Geographic differences significantly influenced prices, with median TAVR prices ranging from $54,915 in New England to $105,538 in the Pacific region (Fig 1A). Aetna had the highest median TAVR price at $84,190, with a standard deviation of $53,186. Medicare had the lowest median price at $37,865 and the least variability, with a standard deviation of $7,566. HMO/Managed Care plans showed the highest prices and variability, with an average median price of $78,725 and a standard deviation of $54,082 (Fig 1B). Medicare Advantage plans had substantially lower rates, with an average median price of $38,044 and a standard deviation of $14,890. Conclusion: This study highlights substantial TAVR price variation across major insurers and plan types. Aetna had the highest prices and variability, particularly in HMO/Managed Care plans, while Medicare Advantage plans had lower prices and variability compared to HMO/Managed Care plans. These findings emphasize the need for greater transparency and standardization in TAVR pricing to reduce disparities and control healthcare costs.