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The Choice of Transcatheter Aortic Valve Implementation (TAVI): Do Patient Co-morbidity and Hospital Ownership Type Matter?

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Abstract

Background

Innovative technologies challenge healthcare systems, as evidence on costs and benefits frequently usually are slow to reflect new technology. We investigated these dynamics for Germany, using the emergence of transcatheter aortic valve implementation (TAVI) as an alternative to conventional aortic valve replacements (CAVR).

Objective

We focused on the role of patient co-morbidity—which would be a medical explanation for adopting TAVI—and hospital ownership status, hypothesizing that for-profit facilities are more likely to capitalize on the favorable reimbursement conditions of TAVI.

Methods

The analysis uses claims data from the Techniker Krankenkasse, the largest health insurance fund in Germany, for the years 2009–2015, covering 2892 patients with TAVI and 9523 with CAVR. The decision on TAVI versus CAVR was estimated for patient-level data, that is, socioeconomic data as well as co-morbidity. At the hospital level, we included the ownership type. We also controlled for effects of the respective owner (rather than the type of ownership), including a random intercept.

Results

While the co-morbidity score of TAVI patients was much higher in the early years, over time, the score almost converged with that of CAVR patients. This is in agreement with emerging evidence that suggests the use of TAVI also leads to better patient outcomes. Our results indicate that the type of ownership does not drive the switch to TAVI. We found little, if any, effect from the respective owner, regardless of ownership type.

Conclusion

Overall, the effects of co-morbidity suggest that providers acted responsibly when adopting TAVI while evidence was still emerging.

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Author information

Authors and Affiliations

  1. WINEG-Scientific Institute of TK for Benefit and Efficiency in Health Care, Bramfelder Str. 140, 22305, Hamburg, Germany

    Udo Schneider, Roland Linder & Dirk Horenkamp-Sonntag

  2. Department of Law and Economics, JP Health Care Management, University of Bayreuth, Universitätsstr. 30, 95447, Bayreuth, Germany

    Andreas Schmid

  3. Techniker Krankenkasse, Bramfelder Str. 140, 22305, Hamburg, Germany

    Frank Verheyen

Authors
  1. Udo Schneider
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  2. Andreas Schmid
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  3. Roland Linder
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  4. Dirk Horenkamp-Sonntag
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  5. Frank Verheyen
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Contributions

Udo Schneider was responsible for the study design, the statistical analysis, and the preparation of the manuscript draft. Andreas Schmid prepared data for hospital ownership and contributed to the statistical analysis, literature review, and the final manuscript. Roland Linder was responsible for the medical setting of the study and critical assessment of the statistical analysis. Dirk Horenkamp-Sonntag designed the pick-up of the diagnoses for the co-morbidity index and its interpretation. Frank Verheyen was responsible for study design and study co-ordination.

Corresponding author

Correspondence to Udo Schneider.

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Conflict of interest

No funding was received for the study. Udo Schneider, Andreas Schmid, Roland Linder, Dirk Horenkamp-Sonntag, and Frank Verheyen declare that they have no conflicts of interest.

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Schneider, U., Schmid, A., Linder, R. et al. The Choice of Transcatheter Aortic Valve Implementation (TAVI): Do Patient Co-morbidity and Hospital Ownership Type Matter?. Appl Health Econ Health Policy 16, 735–744 (2018). https://doi.org/10.1007/s40258-018-0414-6

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  • DOI: https://doi.org/10.1007/s40258-018-0414-6

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