RESUMO
OBJECTIVES: Our objectives were to assess the evolution of surgical and endovascular mitral valve procedural volumes and to study utilization and reimbursement effects of transcatheter mitral valve repair (TMVR) at our center and to put these in perspective with the corresponding data at the national level. BACKGROUND: TMVR using the MitraClip system has been available in Germany since 2008 as a complementary treatment option for high-risk or inoperable patients. METHODS: Relevant procedure codes were identified for 2006-2012 and yearly utilization volumes obtained from our center's databases and from the national statistics office. Volumes were analyzed in total, and stratified by treatment approach. Procedure reimbursement at our center was determined for years 2007-2012. RESULTS: At our center, 378 MitraClip procedures were performed from 2008 to 2012. During this period, surgical volumes grew at an average of 10.6% annually (2008: 262; 2012: 392; 49.6% total growth rate). Total surgical and TMVR reimbursement increased from EUR 3.8 million (2007) to EUR 7.9 million (2012). By comparison, mitral valve procedural volumes grew by 56.1% from 2006 to 2012 at the national level, with TMVR constituting 9.1% of 20,328 procedures in 2012. Since the introduction of MitraClip, nationwide surgical procedural volumes grew at an average of 6.3% annually (2008: 14,477; 2012: 18,478; 27.6% total growth rate). CONCLUSIONS: Growth in procedural volumes during 2006-2012 reflects an increasing supply and subsequent demand for mitral valve procedures. The introduction of TMVR has contributed to overall growth, and has not reduced continued growth in surgical volumes. Our center-specific analysis suggests a "halo effect" of an integrated approach to mitral valve disease contributing to additional growth in surgical and overall reimbursement volumes.
Assuntos
Angioplastia/estatística & dados numéricos , Cateterismo Cardíaco , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/terapia , Estenose da Valva Mitral/terapia , Idoso , Angioplastia/métodos , Estudos de Coortes , Ecocardiografia , Feminino , Alemanha , Pesquisas sobre Atenção à Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/mortalidade , Prognóstico , Implantação de Prótese/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
AIMS: The German healthcare system was among the first to introduce transcatheter mitral valve repair (TMVR) into routine care. The objective of this study was to analyse adoption and utilisation patterns and to estimate the impact of TMVR availability on mitral valve (MV) procedure volumes in the first eight years after commercialisation. METHODS AND RESULTS: Procedure volumes were collected from German Federal Statistics Office databases for TMVR and mitral valve surgery (MVS) from 2008-2015. Procedure volumes were stratified by age group (<65, 65-74, 75-84, ≥85 years). Overall procedure volumes grew from 14,525 to 24,898 (+71%). MVS procedures grew from 14,477 to 20,402 (+41%) (p=0.008). The proportion of TMVR procedures grew from 0.3% (48 procedures) to 18.1% (4,496 procedures) (p=0.008). In 2015, TMVR use reached 5%, 15%, 31%, and 68% of overall MV procedures in the studied age groups (<65, 65-74, 75-84, ≥85 years). MVS volumes grew in all age groups, with the highest increase in the age group <65 (+2,945). CONCLUSIONS: The availability of TMVR has contributed to a pronounced increase in MV procedure volumes in Germany. Simultaneously, MVS procedure volumes continued to grow substantially. The highest increase of TMVR was observed in elderly populations, suggesting referral of patients with MV disease previously left untreated.