Background and aim: Percutaneous aortic valve replacement (TAVI) has, for several years, become an alternative to surgical aortic valve replacement (SAVR) for patients with severe, symptomatic aortic valve stenosis. A systematic review of health economic evaluations of TAVI vs. SAVR (part 1) is complemented here with a data analysis of aortic valve replacement in Austria (part 2).

Method: A secondary analysis of reimbursement data (DRG-data) from public hospitals ("Fondskrankenanstalten") was conducted in order to determine how Aortic Valve Replacement was implemented 2009-2016, either percutaneously (TAVI) or surgically (SAVR), in the Austrian healthcare system. The data source was the Federal Ministry of Health (MoH).

Results: For the period 2009 to 2016, 4,338 TAVI and 16,439 surgical aortic valve replacements (SAVR) were carried out in total. During this period the data show a constant rise in TAVI and a slight fall in SAVR use. Deaths occurred in 4.86 % of the TAVI cases and in 4.67 % of the SAVR cases. In addition, other outcomes such as: strokes (1.82 %/1.75 %), implementation of pacemakers (10.70 %/3.24 %) and bleeding and haematomas (3.02 %/ 5.57 %), were also analysed. The average duration of hospitalisation (lengths of stay/LOS) for patients who were treated with TAVI was less than with SAVR (13 vs. 18 days); the accumulated scoring points (DRG-reimbursement) were however higher (2016: 34,736.74 vs. 25,015.35).

Limitations: Due to the use of routine data collected for reasons of reimbursement, the interpretation of the data has to be considered with caution. In addition, it may be assumed that there is an underreporting of complications in routine data. It is not possible to make any quality assumptions based on these routine data.

Conclusions: Implementation is lower in Austria than in Germany and Switzerland: The analysed data show a rate of 107 TAVI per million inhabitants in Austria. This is below the rates reported for Germany and Switzerland (2014: 163 and 127 TAVI per million inhabitants, respectively). The analysed data show that there is minimal regional variation between the federal states, both for the use of TAVI and for SAVR. Overall there are signs that TAVI is being used according to predefined guideline-based patient selection criteria in Austria. Further in-depth investigations that include analyses of data after hospital-dismissal are recommended.