| Autor: |
Hostetter, Logan, Monlezun, Dominique, Thannoun, Tariq, Pabba, Krishna, Lawless, Sean M, Patel, Ritesh, Grable, Cullen, Zheng, Danyi, Chen, Natalie, Palaskas, Nicolas, Lopez-Mattei, Juan, Kim, Peter, Cilingiroglu, Mehmet, Marmagkiolis, Konstantinos, Iliescu, Cezar |
| Zdroj: |
Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 1 pA14614-A14614, 1p |
| Abstrakt: |
Introduction:Transcatheter aortic valve replacement (TAVR) has been shown to be clinically and financially superior to surgical AVR (SAVR) in severe aortic stenosis (SAS), even in patients at low surgical risk. To date, there is no multi-center analysis of inpatient mortality, total costs, and racial and income disparities of TAVR in patients with cancer.Methods:Machine learning-augmented propensity score adjusted multivariable regression was utilized to compare medical management, TAVR, and SAVR using a nationally representative all payor inpatient dataset from 2016 (the National Inpatient Sample). Regression analysis was compared to backward propagation neural network machine learning for total cost; fully adjusted for age, race, income, cancer metastases, and mortality risk.Results:Of 6,033,643 adult hospitalizations, 8,053 (0.13%) underwent TAVR and 13,992 (0.23%) underwent SAVR. In fully adjusted analysis for all hospitalized adults, TAVR compared to medical therapy significantly reduced malignancy patients? length of stay (LOS) (beta days -0.72, 95%CI -1.04- -0.40; p<0.001) and total cost also controlling for LOS (beta USD $-5,186, 95% CI -8,627.01- -1,745.08; p=0.003). TAVR versus SAVR did not significantly increase total costs for malignancy patients (p=0.063). TAVR reduced LOS by nearly four days (p<0.001) for patients overall, but LOS was not significantly affected for patients with malignancy (p=0.214). TAVR significantly decreased mortality overall (OR 0.49, 95% CI 0.41-0.60; p<0.001). TAVR reduced mortality, but not significantly, for cancer patients (OR 0.70, 95%CI 0.45-1.11; p=0.131).Conclusions:This is the first known nationally representative propensity score analysis demonstrating that TAVR versus medical therapy significantly reduces inpatient costs and LOS, while showing comparable performance to SAVR in cancer patients with SAS. TAVR significantly decreased mortality for patients overall, but the mortality benefit was not significant in the malignancy group. Further progress in cancer therapies could close the existing survivorship gap. TAVR appears to be a cost-effective option for treatment of SAS in patients with cancer and may reduce long-term morbidity and mortality. |
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