Transcatheter aortic valve replacement in Europe : adoption trends and factors influencing device utilization
Faculty of Medicine and Health Sciences
New York, N.Y.
Journal of the American College of Cardiology. - New York, N.Y.
, p. 210-219
University of Antwerp
Objectives We sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy. Background Since commercialization in 2007, the number of TAVR procedures has grown exponentially. Methods The adoption of TAVR was investigated in 11 European countries: Germany, France, Italy, United Kingdom, Spain, Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from two sources: (1) lead physicians submitted nation-specific registry data; (2) an implantation-based TAVR-market tracker. Economic indices such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR utilization. Furthermore, we assessed the extent to which TAVR has penetrated its potential patient population. Results Between 2007 and 2011, 34,317 patients underwent TAVR. Considerable variation in TAVR utilization existed across nations. In 2011, the number of TAVR implants per million ranged from 6.1 in Portugal to 88.7 in Germany (mean±standard deviation:33±25). The annual number of TAVR implants performed per center across nations also varied widely (range:10-89). The weighted average TAVR penetration rate was low: 17.9%. Significant correlation was found between TAVR use and healthcare spending per capita (r=0.80,p=0.005). TAVR-specific reimbursement systems were associated with higher TAVR use than restricted systems (698±232vs213±112 implants/million ≥75 years,p=0.002). Conclusions Our findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indices and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.