Transcatheter Aortic Valve Replacement in Europe: Adoption Trends and Factors Influencing Device Utilization

Darren Mylotte; Ruben L J Osnabrugge; Stephan Windecker; Thierry Lefèvre; Peter de Jaegere; Raban Jeger; Peter Wenaweser; Francesco Maisano; Neil Moat; Lars Søndergaard; Johan Bosmans; Rui C Teles; Giuseppe Martucci; Ganesh Manoharan; Eulogio Garcia; Nicolas M Van Mieghem; A Pieter Kappetein; Patrick W Serruys; Ruediger Lange; Nicolo Piazza

doi:10.1016/j.jacc.2013.03.074

Transcatheter Aortic Valve Replacement in Europe: Adoption Trends and Factors Influencing Device Utilization

Darren Mylotte, Ruben L J Osnabrugge, Stephan Windecker, Thierry Lefèvre, Peter de Jaegere, Raban Jeger, Peter Wenaweser, Francesco Maisano, Neil Moat, Lars Søndergaard, Johan Bosmans, Rui C Teles, Giuseppe Martucci, Ganesh Manoharan, Eulogio Garcia, Nicolas M Van Mieghem, A Pieter Kappetein, Patrick W Serruys, Ruediger Lange, Nicolo Piazza

Department of Drug Design and Pharmacology

151 Citations (Scopus)

Abstract

Objectives The authors 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 its 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, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. 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 use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 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 ± 232 vs. 213 ± 112 implants/million individuals ≥75 years; p = 0.002). Conclusions The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	62
Issue number	3
Pages (from-to)	210-219
Number of pages	10
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2013.03.074
Publication status	Published - 16 Jul 2013

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10.1016/j.jacc.2013.03.074

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Mylotte, D., Osnabrugge, R. L. J., Windecker, S., Lefèvre, T., de Jaegere, P., Jeger, R., Wenaweser, P., Maisano, F., Moat, N., Søndergaard, L., Bosmans, J., Teles, R. C., Martucci, G., Manoharan, G., Garcia, E., Van Mieghem, N. M., Kappetein, A. P., Serruys, P. W., Lange, R., & Piazza, N. (2013). Transcatheter Aortic Valve Replacement in Europe: Adoption Trends and Factors Influencing Device Utilization. Journal of the American College of Cardiology, 62(3), 210-219. https://doi.org/10.1016/j.jacc.2013.03.074

Mylotte, D, Osnabrugge, RLJ, Windecker, S, Lefèvre, T, de Jaegere, P, Jeger, R, Wenaweser, P, Maisano, F, Moat, N, Søndergaard, L, Bosmans, J, Teles, RC, Martucci, G, Manoharan, G, Garcia, E, Van Mieghem, NM, Kappetein, AP, Serruys, PW, Lange, R & Piazza, N 2013, 'Transcatheter Aortic Valve Replacement in Europe: Adoption Trends and Factors Influencing Device Utilization', Journal of the American College of Cardiology, vol. 62, no. 3, pp. 210-219. https://doi.org/10.1016/j.jacc.2013.03.074

@article{188afdff886747bb9e55491260f4acfe,

title = "Transcatheter Aortic Valve Replacement in Europe: Adoption Trends and Factors Influencing Device Utilization",

abstract = "Objectives The authors 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 its 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, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. 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 use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 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 ± 232 vs. 213 ± 112 implants/million individuals ≥75 years; p = 0.002). Conclusions The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.",

author = "Darren Mylotte and Osnabrugge, {Ruben L J} and Stephan Windecker and Thierry Lef{\`e}vre and {de Jaegere}, Peter and Raban Jeger and Peter Wenaweser and Francesco Maisano and Neil Moat and Lars S{\o}ndergaard and Johan Bosmans and Teles, {Rui C} and Giuseppe Martucci and Ganesh Manoharan and Eulogio Garcia and {Van Mieghem}, {Nicolas M} and Kappetein, {A Pieter} and Serruys, {Patrick W} and Ruediger Lange and Nicolo Piazza",

year = "2013",

month = jul,

day = "16",

doi = "10.1016/j.jacc.2013.03.074",

language = "English",

volume = "62",

pages = "210--219",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

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TY - JOUR

T1 - Transcatheter Aortic Valve Replacement in Europe

T2 - Adoption Trends and Factors Influencing Device Utilization

AU - Mylotte, Darren

AU - Osnabrugge, Ruben L J

AU - Windecker, Stephan

AU - Lefèvre, Thierry

AU - de Jaegere, Peter

AU - Jeger, Raban

AU - Wenaweser, Peter

AU - Maisano, Francesco

AU - Moat, Neil

AU - Søndergaard, Lars

AU - Bosmans, Johan

AU - Teles, Rui C

AU - Martucci, Giuseppe

AU - Manoharan, Ganesh

AU - Garcia, Eulogio

AU - Van Mieghem, Nicolas M

AU - Kappetein, A Pieter

AU - Serruys, Patrick W

AU - Lange, Ruediger

AU - Piazza, Nicolo

PY - 2013/7/16

Y1 - 2013/7/16

N2 - Objectives The authors 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 its 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, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. 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 use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 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 ± 232 vs. 213 ± 112 implants/million individuals ≥75 years; p = 0.002). Conclusions The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.

AB - Objectives The authors 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 its 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, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. 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 use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 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 ± 232 vs. 213 ± 112 implants/million individuals ≥75 years; p = 0.002). Conclusions The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.

U2 - 10.1016/j.jacc.2013.03.074

DO - 10.1016/j.jacc.2013.03.074

M3 - Journal article

C2 - 23684674

SN - 0735-1097

VL - 62

SP - 210

EP - 219

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 3

ER -

Transcatheter Aortic Valve Replacement in Europe: Adoption Trends and Factors Influencing Device Utilization

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