In a commercially insured population with aortic stenosis, TAVR was associated with lower standardized index hospitalization costs across all HFRS strata and lower standardized 1-year costs in the low and intermediate HFRS strata, but baseline frailty and procedural scope (isolated vs. concomitant procedures) are critical determinants of cost differences between TAVR and SAVR.
The study identified 3,623 commercially insured patients with aortic stenosis who underwent AVR, with SAVR patients outnumbering TAVR patients roughly 2.8 to 1.
TAVR was associated with significantly lower index hospitalization costs than SAVR in all three frailty strata.
Cumulative 1-year costs were significantly lower with TAVR in the low and intermediate HFRS strata but not significantly different in the high HFRS stratum.
When restricted to isolated AVR, the 1-year cost advantage of TAVR was no longer significant in the low and intermediate HFRS strata and was numerically reversed in the high HFRS stratum.
The authors conclude that baseline frailty and procedural scope are critical determinants of short- and intermediate-term cost differences between TAVR and SAVR in commercial populations.
This study used insurance claims data to compare the costs of two ways of replacing a narrowed aortic valve in people with commercial (non-Medicare) health insurance: open-heart surgery (SAVR) and a less invasive catheter-based procedure (TAVR). It included 3,623 patients treated between 2019 and 2022 and grouped them by frailty level (low, intermediate, high). TAVR had lower hospital costs for the initial procedure in all frailty groups, by roughly $39,000 to $42,000. Over the full first year, TAVR was also significantly cheaper for patients with low and intermediate frailty, by about $32,000 and $41,000. For the most frail patients the difference was similar in size but was not statistically significant, so it could be due to chance. When the analysis was limited to patients who had only a valve replacement (no additional heart procedures), the one-year cost advantage for TAVR mostly disappeared in the low and intermediate groups and numerically reversed in the high-frailty group. This research suggests that cost differences between the two approaches depend heavily on how frail patients are and whether other procedures are done at the same time. As a claims-based study, it shows associations in costs rather than proving that one approach causes lower costs.
Baron S, Galper B, Kelley M, Chikermane S, Murphy S. (2026). Comparison of 1-year costs of commercially insured patients with severe aortic stenosis undergoing surgical vs. transcatheter aortic valve replacement.. Journal of medical economics. https://doi.org/10.1080/13696998.2026.2752763