Valvular & structural heart disease
Contribution margins and utilization of transcatheter aortic valve replacement versus surgical aortic valve replacement in the Medicare population
Authors' conclusion
Most hospitals had positive CMs for TAVR and nearly all had positive CMs for SAVR. Positive CMs for TAVR for individual hospitals were associated with a significant increase in the utilization of TAVR. However, the magnitude of difference in TAVR versus SAVR CM was not associated with differential procedural use.
Study context
- Population
- Fee-for-service Medicare beneficiaries undergoing isolated transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR), US, 2016–2019
- Participants
- 542 sites
- Exposure
- TAVR vs SAVR contribution margins and utilization
- Outcome
- Contribution margin (total revenues minus total direct costs) per procedure
Methodological detailshospital-level analysis, multivariate logistic and linear regression
- Hospital-level analysis
- Multivariate logistic and linear regression
Main finding
As reported in the abstract
Hospitals with positive CMs
| Group | Value | Negative contribution margin (CMs) |
|---|---|---|
| TAVR | 69.6% | 165 (30.4%) |
| SAVR | 93.2% |
Value
TAVR69.6%
SAVR93.2%
Negative contribution margin (CMs)
TAVR165 (30.4%)
SAVR— not stated in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | aOR (95% CI) | |
|---|---|---|
| Hospital characteristics associated with positive TAVR CMsTeachingvs NonteachingMultivariate logistic regression | 1.77 (1.07–2.93) | |
| Hospital characteristics associated with positive TAVR CMsFor-profitvs NonprofitMultivariate logistic regression | 3.7 (1.8–7.6) | |
| 0.10.31310Adjusted odds ratio (log scale) |
Median
| Outcome | Positive TAVR CMs | Negative TAVR CMs | P value |
|---|---|---|---|
| Median (IQR) proportion of TAVR of total AVR, by TAVR CM | 76.67% (IQR 69.6%–82.5%) | 74.6% (IQR 66.9%–80.4%) | P = 0.04 |
Median total CM per hospital for TAVR, 2016 vs 2019
- TAVR median (IQR) CM 2016
- $10,574 ($1,331-$22,259)
- TAVR median (IQR) CM 2019
- $6,744 ($6,099-$17,511)
- Decrease 2016 to 2019
- P < 0.001
- Median revenues, costs and CMs for TAVR decreased between 2016 and 2019
Hospital-level TAVR vs SAVR CM difference and proportion of TAVR of total AVR
- No significant linear relationship in multivariate models
Original publication
Contribution margins and utilization of transcatheter aortic valve replacement versus surgical aortic valve replacement in the Medicare population. Am Heart J. Published 27 November 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →