Pietzsch JB, Busca R, Geisler BP. Adoption of transcatheter aortic valve replacement in Germany: utilization patterns and case volumes compared to surgical aortic valve replacement in the period 2009–2013 [Presentation to the 2015 annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research, abstract PMD145]. Value Health. 2015;18(7):A370; doi: 10.1016/j.jval.2015.09.747.

Objectives. The German healthcare system was among the first markets to introduce transcatheter aortic valve replacement (TAVR) in routine care. Our objective was to estimate the impact of TAVR availability on overall aortic valve replacement volumes and competing therapies in this real-world setting.

Methods. Therapy- and age-specific procedure volumes were collected from German Federal Statistics Office databases for TAVR and surgical aortic valve replacement (SAVR) via sternotomy for years 2009 through 2013. Discharge and hospital-based mortality data were obtained for the same period based on applicable ICD-10 diagnosis. We computed therapy-specific and total procedure volumes and growth stratified by five-year age increments and in total. Discharge and mortality data for aortic valve disease hospitalizations were assessed to obtain an estimate of charges in per-case mortality.

Results. In the time period 2009 to 2013, overall procedure volumes grew from 26,466 to 33,235 (+26%). This growth was driven by TAVR (3,411 to 10,814; +217%), while SAVR volumes remained stable (23,055 to 22,421; –3%). In patients 75 years or older an overall procedure growth of 51% was observed (12,168 to 18,318), with volumes in older patient segments growing more heavily (+62% in >80-year-olds; +101% in >85-year-olds).

Across all elderly age groups, SAVR volumes decreased (–20% in >80-year-olds; –37% in >85-year-olds), while they grew in selected younger patient groups (highest growth+30% in age group 60–64 years). Concurrently, total aortic valve disease hospital discharges grew by 26%, from 44,161 to 55,748, while mortality per hospitalization case decreased by 5% between 2009 and 2013.

Conclusions. The availability of TAVR has contributed to substantial growth in aortic valve replacements in Germany, specifically in elderly populations previously left untreated. This growth was associated with a concurrent gradual decline in overall mortality of aortic valve-related hospitalizations.