Use of an Aortic Valve Replacement Simulation Model to Understand Hospital Costs and Resource Utilization Associated With Rapid-deployment Valves

Autor: Eugenio Novelli, Gian Luca Martinelli, Attilio Cotroneo, Edmond Stelian, Enrico Visetti, Mario Bobbio, Giuliana Barbieri, Rachele Freddi
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
02 engineering and technology
030204 cardiovascular system & hematology
law.invention
03 medical and health sciences
Young Adult
020210 optoelectronics & photonics
0302 clinical medicine
Aortic valve replacement
law
0202 electrical engineering
electronic engineering
information engineering
Medicine
Humans
Pharmacology (medical)
Heart valve
Resource consumption
Hospital Costs
Aged
Pharmacology
Aged
80 and over
Heart Valve Prosthesis Implantation
business.industry
valvular heart disease
Aortic Valve Stenosis
Length of Stay
Middle Aged
medicine.disease
Intensive care unit
Stenosis
medicine.anatomical_structure
Models
Economic
Treatment Outcome
Italy
Software deployment
Aortic Valve
Heart Valve Prosthesis
Emergency medicine
Female
business
Resource utilization
Zdroj: Clinical therapeutics. 42(12)
ISSN: 1879-114X
Popis: Purpose Aortic stenosis (AS) is the most common cause of adult valvular heart disease. In the past decade, minimally invasive surgery (MIS) to treat AS has gained popularity, especially if performed in combination with rapid deployment valves (RDVs), which shorten cross-clamp time (XCT). This study examines specific outcomes and related costs of aortic valve replacement (AVR) before and after the introduction of RDVs. Methods We used the AVR simulator, an economic model developed to correlate cost and resource utilization associated with the adoption of RDVs, to compare 2 scenarios: (1) a current scenario based on standard AVR practices and (2) a proposed scenario based on increasing use of RDVs and an MIS approach. Both scenarios involved 3 subgroups of patients treated with (1) conventional AVR, (2) MIS, and (3) AVR combined with a coronary artery bypass graft. The current scenario (status quo) involved patients treated with traditional biological valves, and the proposed scenario involved patients who underwent implantation with an RDV. The AVR simulator was fed with real-world input data to estimate complication rates and resource consumption in the proposed scenario. Real-world input data for this analysis were obtained from patients diagnosed with a symptomatic heart valve disease between 2015 and 2018, at Clinica-San-Gaudenzio, Novara, Italy. Lastly, the AVR simulator estimated hospital savings by comparing the 2 scenarios. Findings A total of 132 patients underwent implantation with a traditional biological valve, and 107 were treated with a commercial valve system. The RDV was associated with an increase of 52% of patients undergoing MIS, which generated a 6.1-h reduction of XCT and a total savings of €6695. RDVs also reduced intensive care unit (ICU) and hospital ward length of stay (LOS), leading to savings of €677 and €595 per patient, respectively. Mortality and blood transfusions also improved. The savings for the hospital (related to shorter XCT, hospital ward LOS, and ICU LOS) amounted to €144.111. Our findings were consistent with data gathered from our real-word setting, and results of a sensitivity analysis indicate that our findings were robust across different possible situations. Implications Switching to RDVs and MIS procedures for AVRs was associated with a reduction of costs related to XCT, hospital ward LOS, and ICU LOS. Hospitals can upload literature- and experience-based clinical and cost values to the AVR simulator to estimate a hospital's performance with the introduction of RDVs compared with standard biological valves. This study was not randomized, so more extensive studies could confirm our results in the future.
Databáze: OpenAIRE
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