Transcatheter Aortic Valve Implantation in Patients at Intermediate and Low Risk Is Not (Yet) the Existential Threat That Surgeons Feared: A Retrospective Analysis of Medicare Claims Data.

Abstract

Background: In Australia, the role of surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in patients who are suitable for both procedures remains controversial. In 2022, new Items were added to the Medicare Benefits Schedule (MBS) to allow patients at intermediate and low risk with appropriate private health insurance to undergo TAVI. The Cardiac Society of Australia and New Zealand supported these changes whereas the Australian and New Zealand Society of Cardiac and Thoracic Surgeons opposed them. The aim of this study was to document subsequent private TAVI activity in patients at intermediate and low risk, relative to both private TAVI activity in patients at high risk and private SAVR activity.

Method: A retrospective population-level descriptive study was undertaken, using Medicare claims data obtained from Services Australia.

Results: Among private patients who underwent TAVI, the groups at high, intermediate, and low risk all had a median age between 75 and 84 years. Only 1% were aged ≤64 years (86/6,586), and 80% of these were at high risk (69/86). Among private patients at intermediate and low risk who underwent TAVI and private patients who underwent SAVR, only 4% of patients aged 55-64 years chose private TAVI over private SAVR (8/211), and 63% of these were at intermediate risk (5/8).

Conclusions: The introduction of MBS Items for private TAVI in patients at intermediate and low risk without accompanying age exclusion criteria has not (yet) had a major impact on private SAVR activity. This suggests that the multidisciplinary heart team (TAVI case conference) approval process remains an effective mechanism for ensuring access to private TAVI is consistent with international guidelines.