Comparison of 1-year costs of commercially insured patients with severe aortic stenosis undergoing surgical vs. transcatheter aortic valve replacement

Patients with aortic stenosis (AS) have been shown to have lower costs at 1 year with transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in a Medicare population. The difference in costs between TAVR and SAVR in commercially insured patients with AS in the United States is unknown. Using the Optum claims database, AS patients receiving either TAVR or SAVR between 3/2019 and 9/2022 were identified. Patients were categorized into low, intermediate or high strata using the Hospital Frailty Risk Score (HFRS). The primary outcome was total 1-year cost, defined as the sum of index AVR hospitalization and 1-year follow-up costs. Risk-adjusted generalized linear models were used to assess the difference in the costs between TAVR and SAVR. 3,623 patients (952 TAVR; 2,671 SAVR) were identified. TAVR patients had lower index hospitalization costs compared with SAVR patients across all HFRS strata (cost difference for low: $39,312, p < 0.01; intermediate: $42,006, p < 0.01; high: $39,431, p = 0.03). Cumulative costs through one year were significantly lower with TAVR in the low and intermediate HFRS strata (cost difference for low: $32,116, p < 0.01; intermediate $40,905, p < 0.01) and numerically lower in the high HFRS stratum (cost difference: $35,881, p = 0.15). When the analysis was restricted to isolated AVR, the 1-year difference was no longer significant in the low and intermediate HFRS strata ($8,064 and $11,314, respectively) and was numerically reversed in the high HFRS stratum (−$28,804). In a commercial payor population of real-world patients with AS, TAVR was associated with lower standardized index hospitalization costs across all HFRS strata and lower standardized 1-year costs in the low and intermediate HFRS strata. These findings demonstrate that baseline frailty and procedural scope are critical determinants of short and intermediate-term cost differences between TAVR and SAVR for the treatment of AS in commercial populations.