A Comparison of the Cost-Effectiveness of Transfemoral Transcatheter Aortic Valve Implantation in Local Anesthesia versus General Anesthesia

Objectives: Transcatheter aortic valve implantation (TAVI) in elective treatment of severe aortic valve stenosis has become widespread over the last 10 years and now accounts for more than half of all aortic valve replacements in Germany. Fast-track protocols have been adopted in hope to reduce procedural costs and improve clinical outcomes. One development was the introduction of transfemoral TAVI performed under mild sedation and local anesthesia instead of general anesthesia. This study aimed to compare cost effectiveness in the use of local anesthesia (LA) versus general anesthesia (GA) in transfemoral TAVI in a high-volume single-center setup.

Methods: A total of 867 patients from January 2016 to December 2018 were analyzed after elective transfemoral TAVI due to severe native aortic valve stenosis. Patients were divided into two groups according to the anesthesiologic strategy used during the procedure (LA = 466, GA = 401). Applying propensity score matching, two matched cohorts were created (LA = 349, GA = 349) based on baseline parameters. InEK cost matrix (German Hospital Reimbursement Institute) and in-hospital outcomes were analyzed and compared between matched groups.

Result: The mean costs per case of all included 698 patients were €20,642. There was no difference in overall direct costs between anesthesiologic strategies (LA €20,562 vs. GA €20,722, p = 0.67). The use of LA was associated with significantly reduced anesthesia monitoring time (167 vs. 183 minutes, p < 0.001), procedure time (57 vs. 69 minutes, p < 0.001) and intensive care unit stay (12 vs. 18 hours, p = 0.02) in matched groups. LA had a significant mean direct-cost reduction of 6.4% and 2.6% in cost centers “anesthesia” and “OR section,” respectively. “ICU” center costs in contrast did not differ significantly.

Conclusion: A clear benefit of TAVI in LA was reduced procedure and anesthesia monitoring time as well as shorter ICU stay. The study demonstrated that time efficiency translated to cost-effectiveness as transfemoral TAVI in LA showed significant decrease in cost centers “anesthesia” and “OR section” but no reduction in direct overall costs.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021