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Transcatheter Aortic Valve Replacement: Variations in Use, Charges, and Geography in the United States - 18/09/23

Doi : 10.1016/j.amjcard.2023.07.151 
Ayman R. Fath, MD a, Amro Aglan, MD b, Aditya Khurana, MD c, Jumanah Abuasbeh, MD, MPH d, Abdullah S. Eldaly, MD e, Yogamaya Mantha, MD a, Bishoy Abraham, MD f, Abdulbaril Olagunju, MD g, Anand Prasad, MD a,
a Department of Cardiovascular Diseases, University of Texas Health Science Center, San Antonio, Texas 
b Department of Internal Medicine, Beth Israel Lahey Health, Boston, Massachusetts 
c Department of Radiology, Mayo Clinic, Rochester, Minnesota 
d Department of Public Health, University of Arizona, Phoenix, Arizona 
e Department of Surgery, Mayo Clinic, Jacksonville, Florida 
f Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona 
g Department of Internal Medicine, Creighton University, Phoenix, Arizona 

Corresponding author: Tel: +1 (210) 567-4601.

Riassunto

The use of transcatheter aortic valve replacement (TAVR) in the United States has been increasing but with variability. We used a 100% sample of Medicare beneficiaries (MBs), from the Centers for Medicare and Medicaid Services database, who underwent TAVR by cardiologists between 2015 and 2019. We stratified data by geographic region, rural/urban areas, and provider's gender. We examined the average number of TAVRs performed per 100,000 MBs, the average number of TAVRs performed per individual cardiologist, and the average submitted charge (ASC) per procedure. The number of TAVR per 100,000 MBs was significantly variable among regions in all years (all P≤0.028), except in 2015 (P=0.103), with the highest rates being in the Northeast and the lowest being in the West. The number of TAVRs per cardiologist was significantly different among regions only in 2019 (P=0.04), with the Northeast showing the highest numbers and the South showing the lowest. The ASC was also significantly variable among regions in all years (all P≤0.01). The highest ASC was in the Midwest for all years, whereas the lowest was in the West in 2015 to 2016 and in the South in 2017 to 2019. In all years, the number of TAVRs per cardiologist was higher in urban areas than in rural areas (all P<0.05); however, rural cardiologists had higher ASCs (all P<0.05). The number of TAVR procedures per cardiologist was not significantly different between male and female cardiologists (all P>0.1). Female cardiologists had a significantly higher ASC only in 2015 (P=0.034). In conclusion, there are variations in TAVR use and charges for MBs according to geographic, urban, and rural regions and the performing cardiologist's gender.

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Keywords : Transcatheter aortic valve replacement, TAVR, Variation in Utilization, Charges, Reimbursement, Geographic distribution, Cardiologist gender, Rural and Urban


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 Funding: none.


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Vol 205

P. 363-368 - ottobre 2023 Ritorno al numero
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