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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Present and future economic impact of Transcatheter Aortic Valve Implantation (TAVI) in Portugal National Healthcare System
Session:
Posters 5 - Écran 10 - Economia na Saúde / Saúde Pública
Speaker:
C. M. Espada Guerreiro
Congress:
CPC 2019
Topic:
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Theme:
34. Public Health and Health Economics
Subtheme:
34.3 Health Economics
Session Type:
Posters
FP Number:
---
Authors:
C. M. Espada Guerreiro; Ricardo Fontes-Carvalho; Maria Clara Castro; Pedro Braga
Abstract
<p><strong>Background</strong>: TAVI has changed the treatment paradigm for inoperable, high and gradually intermediate risk aortic stenosis (AS) patients. In Portugal, TAVI penetration rate is still low. There is a lack of health economics information regarding the impact of TAVI in the national healthcare system.</p> <p> </p> <p><strong>Aims: </strong>To perform an economic analysis of the present and future impact of TAVI in Portugal and propose health policy recommendations for a specific reimbursement model.</p> <p> </p> <p><strong>Methods</strong>: The current fixed costs of a TAVI procedure were calculated using the 2017 hospital data information collected from a portuguese terciary centre. To estimate the variable costs we retrospectively analyzed the risk and complications associated with the procedure. Penetration rates were determined using the Portuguese National Registry of TAVI, which were compared with other EU countries data. To predict the future demand for the technology, three scenarios (S) were built according to the Portuguese demography, disease incidence and expected expansion of TAVI clinical indications (S1-TAVI penetration according to current guidelines; S2-indications expanded to intermediate risk patients; S3-low risk patients).</p> <p> </p> <p><strong>Results</strong>: The total cost of TAVI in Portugal was 22.134,5€ with the self-expanding valve (SEV) and 23.321,5€ with the balloon-expanding valves (BEV). Most of this cost (SEV 74,5% vs BEV 83,6%) was driven by the prosthesis price. The total cost of hospitalization was significantly lower compared to other countries (eg US $78.542). The risks of complications were slightly lower with the BEV (296,2€ vs 337,4€), albeit not sufficient to reduce the total cost because it’s prevalence was low. There was an exponential increase in TAVI procedures within the last 5 years; in 2017, 120 TAVI were performed in our centre. Indeed, the penetration rate in Portugal (53 procedures/million in 2017) increased in the last five years but is still much lower than in most EU countries (eg Germany 227/million). Based on current guidelines (S1), the expected penetration rate should be 189/million, which can significantly increase if the current indications expands towards lower risk patients (S2: +28% increase to 241 procedures/million; S3: +107% increase to 391 procedures/million). The current reimbursement model can compromise the anticipated future, taking in consideration, for example, that nowadays it covers only 10.3% of TAVI total cost.</p> <p> </p> <p><strong>Conclusions</strong>: The number of TAVI procedures increased exponentially and are associated with a significant economic impact in Portugal. The future demand for TAVI may increase from 53 to 241 (S2) and 391 (S3) procedures/million habitants. The current model of reimbursement is however misadjusted to this reality. An independent line of hospital reimbursement should be created that can increase patient’s access to the technology and control costs, while maintaining good quality of care.</p>
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