628 Transcatheter Aortic Valve Implantation (TAVI) Versus Surgical Aortic Valve Replacement (SAVR) for Aortic Stenosis: A Cost-Comparison Study

To estimate short-term costs of transcatheter aortic valve implantation (TAVI) and isolated surgical aortic valve replacement (SAVR) for patients with aortic stenosis, stratified by Society of Thoracic Surgery (STS) risk scores. Retrospective analysis of consecutive patients with a principal diagnosis of aortic stenosis who underwent isolated valve replacement at a single tertiary hospital, January 2012-December 2017. Patients followed-up for 30 days post-procedure or first hospital discharge. ICU and hospital length of stay (days) for the index procedure and healthcare costs including rehabilitation at 30 days, reported in 2018 Australian dollars, adjusted for STS risk. Of 488 patients, 61% males, mean age 76 years (SD 12), 221 (45%) received TAVI and 267 (55%) received SAVR. STS risk group for TAVI patients was low in 28%, intermediate (46%) and high (26%); and for SAVR was low in 85%, intermediate (12%), and high (3%). Adjusted ICU and hospital length of stay were shorter for TAVI compared with SAVR by 3 (95% CI 2-3, p<0.001) and 8 (95% CI 5-10, p<0.0001) days respectively. Total adjusted costs including the index procedure and 30-day follow-up were lower for patients undergoing TAVI compared with SAVR by $7,654 (95% CI $2,043-$13,266, p=0.008). This data suggests ICU and hospital length of stay and short-term healthcare costs were significantly lower for patients undergoing TAVI than SAVR. If long term benefits of TAVI are demonstrated, further roll-out of the TAVI program in hospitals across Australia may result in substantial savings to the health system.