Procedural Pattern, Clinical Outcomes, and Cost Analysis of Transcatheter Aortic Valve Replacement in Korea

BACKGROUND: Little information exists about national-based data on patients undergoing transcatheter aortic valve replacement (TAVR) in Asia and the associated costs. OBJECTIVES: This study aims to assess the baseline characteristics, procedural patterns, clinical outcomes, and cost expenses of patients with severe aortic stenosis who underwent TAVR in Korea. METHODS: We used the patient-level data from the National Health Insurance Review and Assessment Service registry, spanning from May 2015 to June 2021. The primary clinical outcome was all-cause mortality. Rehospitalization rates and procedural costs were also analyzed. RESULTS: During the study period, 3,463 patients (mean age: 80.5 ± 5.9 years; 54.0% female) underwent TAVR at 39 hospitals in Korea. The annual number of TAVR procedures and the number of performing centers increased steadily. The proportion of low-risk patients (Society of Thoracic Surgeons Predicted Risk of Mortality ≤4%) was 41.7%. The transfemoral approach was conducted in 99.0% of cases, and the procedural success rate was 99.7%. All-cause mortality rates at 30 days, 2 years, and 5 years were 2.7% (95% CI: 2.1-3.2), 12.9% (95% CI: 11.8-14.0), and 19.5% (95% CI: 18.0-21.1), respectively. Rehospitalization related to cardiovascular causes occurred in 31.7% (95% CI: 29.3-34.1) at 2 years and 40.5% (95% CI: 34.1-46.9) at 5 years. The estimated mean index cost per patient was $32,173 ± $7,552, with 83.2% attributed to material expenses. CONCLUSIONS: The number of TAVR recipients and performing centers in Korea has substantially increased over time. The procedural and survival outcomes were favorable. The overall medical costs for TAVR procedures are still substantial, mainly driven by device costs.