Geisler BP, Busca R, Pietzsch JB. The impact of transcatheter aortic valve replacement on therapy utilization and case volumes in Germany, 2009–2013. [Presentation to the 2015 Transcatheter Cardiovascular Therapeutics conference, abstract TCT-157]. J Am Coll Cardiol. 2015;66(15, Suppl B):B56; doi: 10.1016/j.jacc.2015.08.168.

Objectives. Our objective was to estimate the effects of the availability of transcatheter heart valve replacement (TAVR) on overall heart valve replacement volumes and aortic valve disease mortality over a long-term horizon. Our study uses the German healthcare system as a reference case, as it was among the first systems adopting TAVR therapy for routine care.

Methods. We collected therapy- and age-specific procedure volumes from records of the German Federal Statistics Office for TAVR and surgical aortic valve replacement (SAVR) procedures for years 2009–2013. Relevant ICD-10 diagnosis-based information about discharges and hospital-based mortality were obtained for the same period. 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 was assessed to obtain an estimate of changes in per-case mortality.

Results. Overall procedure volumes grew from 26,466 in 2009 to 33,235 in 2013 (+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 yrs.). 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.Five-year real-world data from the German healthcare system demonstrate that the availability of TAVR has led to substantial growth in aortic valve replacements. TAVR substantially increased volumes in the elderly population, and partially replaced SAVR treatments in this subgroup. Concurrently, increased therapy utilization in patients previously left untreated was associated with a reduction in overall mortality of aortic valve-related hospitalizations. Further analysis is warranted to compare these data with the German Registry as well as replicate them in other countries, if possible stratified by pre-procedure surgical risk.