Mortality Rates in Aortic Valve Replacement: Are Rapid-Deployment Valves like LivaNova Perceval Cost-Effective?

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Heart valve replacement is a competitive field, with many competing options. A recently developed category is rapid deployment valves, which do not require suturing. This allows for much faster implantation. Payors class these valves as experimental, under ICD-10 procedure codes like X2RF032 for open-approach implantation, rather than under the ICD-10 codes like 02RF08Z that conventional heart valves are assigned.

A 2016 expert consensus statement suggested that these valves can reduce hospitalization costs, saying “These clinical outcomes result in reduced intensive care unit and hospital stay and reduced costs.” However, this statement focused on minimally invasive approaches. Dexur analysts examined how open-approach implantation of rapid-deployment valves compares to open-approach implantation of otherwise equivalent conventional valves.

In nationwide 2013-2017 hospital discharge data, open approach rapid deployment zooplastic aortic valve replacements cost an average of $46,508 per discharge. This is higher than the average $45,554 per discharge for open approach zooplastic aortic valve replacements with conventional deployment. However, the mortality rate was 2.26% among rapid deployment discharges, compared with 2.85% among conventional discharges.

This is consistent with a 2017 review that found lower in-hospital mortality rates in Livanova Perceval rapid-deployment valves than in conventional zooplastic aortic valves. (Dexur has further quality outcomes data on the Perceval device here).

The difference in payment per discharge and mortality rates can be taken to imply that using rapid deployment in open approach zooplastic aortic valve replacement costs an additional $1,617 per avoided death. However, this figure must be taken with great caution. There are far fewer rapid deployment procedures than conventional procedures, and the majority are performed by just a few surgeons, listed on Dexur's summary page for the corresponding ICD-10 procedure code. It is possible that more experienced surgeons are more willing to try out experimental procedures, and that if rapid deployment devices were more widely used regression to the mean would moderate their advantages.

ABOUT THE AUTHOR

James Pitt

James Pitt is a science writer with experience in medical devices and textbook publishing. His hobbies include reading, flintknapping, and squinting at RStudio. He received a bachelor's in Human Evolutionary Biology from Harvard.