European Adoption of TAVR in High-Risk Patients Studied

July 9, 2013—In a study on the use of transcatheter aortic valve replacement (TAVR) in Western Europe, investigators concluded that TAVR is underutilized in high- and prohibitive-surgical-risk patients with severe aortic stenosis. The investigators advised that national economic indices and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy. Darren Mylotte, MD, et al published the findings in the Journal of the American College of Cardiology (JACC) (2013;62:210–219).

As noted in JACC, the background of the study is that since its commercialization in Europe in 2007, the number of TAVR procedures has grown exponentially. The authors conducted the study to examine the adoption of TAVR in Western Europe and to investigate factors that may influence the heterogeneous use of this therapy.

The study investigated the adoption of TAVR in 11 European countries, including Germany, France, Italy, the United Kingdom, Spain, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from two sources: submissions by lead physicians to a nation-specific registry and an implantation-based TAVR market tracker. Economic indices such as health care expenditure per capita, sources of health care funding, and reimbursement strategies were correlated to TAVR use. The investigators also assessed the extent to which TAVR has reached its potential patient population.

As summarized in JACC, between 2007 and 2011, 34,317 patients underwent TAVR. The investigators found that considerable variation in TAVR use existed across nations. In 2011, the number of TAVR implantations per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implantations performed per center across nations also varied widely (range, 10–89). The weighted average TAVR use rate was low at 17.9%. Significant correlation was found between TAVR use and health care spending per capita (r = 0.8; P = .005). TAVR-specific reimbursement systems were associated with higher TAVR use than restricted systems (698 ± 232 vs 213 ± 112 implantations/million individuals 75 years or older; P = .002), reported the investigators in JACC.