Transcatheter aortic-valve implantation (TAVI) was performed in around 34,500 patients in 11 European countries in the first five years following European approval of the devices in 2007, new data show.
Writing in the Journal of the American College of Cardiology (published online 15th May 2013, doi: 10.1016/j.jacc.2013.03.074), the authors point out that the number of potential TAVI candidates in the 11 countries surveyed was 158 371, meaning that TAVI remains “greatly underutilised”, with a penetration rate of 17.9%.
Use of the procedure appears to be greatly influenced by how much each country spends on healthcare. Countries, such as the UK, where taxation is the principle source of healthcare funding, have a lower TAVI usage. Almost half of all implants were performed in Germany (45.9%), with Italy (14.9%) and France (12.9%) the next most frequent implanters. The UK was fourth, accounting for 8% of TAVI procedures. Ireland accounted for the smallest proportion of implants (0.4%).
The authors led by Dr Darren Mylotte (McGill University, Montreal, Canada) estimate that in 2011, 36% of patients eligible for TAVI received the procedure in Germany, compared to just 9% in the UK.
However, in an accompanying editorial, Drs John Webb and Marco Barbanti (St Paul’s Hospital, Vancouver, Canada), argue that TAVI may not be so underused and that Mylotte et al. had based their estimate of patients eligible on a “liberal interpretation” of the indication for TAVI.
They point out that TAVI is very expensive, and that “Even a country with a strong economy might find TAVI too costly for individuals in whom conventional surgery or medical management might be considered clinically and socially acceptable”. They conclude that: “Perhaps as the cost differential between transcatheter and surgical valves falls, at least some of the resistance to greater penetration will fade”.