FCR-05
Socioeconomic and Geographic Access to Novel Therapeutics: An Analysis of Growth in Transcatheter Aortic Valve Replacement Programs
Presenter
Ashwin Nathan, M.D., Hospital of the University of Pennsylvania, Philadelphia, PA
Ashwin Nathan, M.D.1, Lin Yang2, Nancy Yang2, Sameed Khatana, MD, MPH3, Elias Dayoub, MD, MPP3, Lauren Eberly, MD, MPH1, Sreekanth Vemulapalli, MD4, Suzanne J. Baron, M.D., FSCAI5, David J. Cohen, M.D., FSCAI6, Nimesh Desai, MD PhD1, Joseph E. Bavaria7, Howard C. Herrmann, M.D., MSCAI7, Peter Groeneveld, MD, MS2, Jay S. Giri, MD, FSCAI1 and Alexander Craig Fanaroff, MD, MHS8, (1)Hospital of the University of Pennsylvania, Philadelphia, PA, (2)University of Pennsylvania, Philadelphia, PA, (3)Hospital of the University of Pennsylvania, Durham, NC, (4)Duke University Medical Center, Durham, NC, (5)Massachusets General Hospital , Winchester, MA, (6)St. Francis Hospital, New York, NY, (7)University of Pennsylvania Health System, Philadelphia, PA, (8)Hospital of the University of Pennsylvania, Gladwyne, PA
Keywords: Cath Lab Administration, Cath Lab Leadership Boot Camp, Diversity Equity and Inclusion (DEI) and TAVI/TAVR/Aortic Valve
Background: Despite the benefits of novel therapeutics, inequitable diffusion of new technologies preferentially to areas with high socioeconomic status may generate disparities in care. We sought to examine the growth of TAVR in the United States to understand the characteristics of hospitals with cardiac surgery capabilities that developed TAVR programs and the socioeconomic status of patients these hospitals served.
Methods: We performed a cross-sectional analysis of Medicare claims data between January 1, 2012 to December 31, 2018. We used linear regression models to compare socioeconomic characteristics of patients treated at hospitals that did and did not establish TAVR programs and described the association between area-level markers of socioeconomic status and TAVR rates.
Results: Between 2012 and 2018, 554 hospitals developed new TAVR programs, including 543 (98.0%) in metropolitan areas, and 293 (52.9%) in metropolitan areas with pre-existing TAVR programs. Compared with hospitals that did not start TAVR programs, hospitals that did start TAVR programs treated patients with higher median household incomes (difference $1,305, 95% CI $134 to $12,477, p=0.03. TAVR rates per 100,000 Medicare beneficiaries were higher in areas with higher median income, despite adjusting for age and clinical comorbidities.
Conclusions: During the initial growth phase of TAVR programs in the U.S., hospitals in metropolitan areas and those serving wealthier patients were more likely to start programs. This pattern of growth has led to inequities in the dispersion of TAVR, with lower rates in poorer communities.