Cost Impact of Pacemaker Implantation after Transcatheter Aortic Valve Replacement

Background:
Transcatheter aortic valve replacement (TAVR) can lead to complete atrioventricular block requiring permanent pacemaker (PPM) implantation. Cost of index hospitalization for such patients is higher than usual. However, the magnitude of this cost is unknown. We have looked at our 5 year TAVR experience to compare the dollar cost for PPM implantation in TAVR.

Methods:
This study is a retrospective analysis of patients undergoing TAVR at our tertiary care center from December 2012 to April 2018. Initial sample size was 435. After excluding the patients with aborted procedures (16) and those with prior history of PPM or implantable cardioverter defibrillator (37), final sample size was 382. Cost for admission was calculated as dollar amount incurred by the hospital. It was separated as direct cost, that is individual to each patient for TAVR admission, and indirect cost which represents overhead costs and is independent of patient volume. Patients were divided into two groups based on whether they received PPM or not. Chi-square test, T-test and logistic linear regression were used for statistical analysis.

Results:
Of 382 patients, 19 (4.9%) required PPM after TAVR. PPM group had a significantly higher ICU hours (52.9 vs. 36.6; p<0.001) and total stay (days) in the hospital (4.51 vs. 3.39;p=0.047). On comparison of two groups, a PPM after TAVR would cost an average of $11,853 more, compared with a regular TAVR admission (p=0.024) (see-Table). Direct and indirect cost of admission was also significantly high for PPM group (p=0.02 and p=0.04).

Conclusions:
PPM implantation adds a significant cost burden to TAVR admission.