Contemporary Resource Use and Costs Among Patients With Medically Managed Severe Aortic Stenosis: Results From a US National Claims Database.

backgroundPatients with severe aortic stenosis (AS) who are managed medically have a poor prognosis. No contemporary studies have examined resource use and costs associated with medical management for severe AS.

methodsUsing the Optum Market Clarity Database, which links electronic health records with cost and use data, we identified patients with documented severe AS between 2016 and 2020 who were eligible for aortic valve replacement but did not undergo treatment within 1 year following diagnosis. Outcomes included health care resource use and costs during the 4-year period following the initial diagnosis. Fine-Gray competing risk models estimated use rates, and the Bang-Tsiatis method quantified use and costs while accounting for censoring.

resultsOver the study period, 6892 patients presented with severe AS, of whom 3334 (48%) were managed medically and 2812 (41%) were similar (based on propensity matching) to those who underwent aortic valve replacement. Over 4 years of follow-up, these patients experienced an average of 1.99 hospitalizations, 1.33 of which were related to a cardiovascular condition. Total costs (including hospitalizations, outpatient care, and pharmacy services) were $126 638 per patient, of which $56 032 was for inpatient care, $31 603 was for outpatient care, and $21 160 was for pharmacy services.

conclusionsIn contemporary practice, despite the availability of effective treatment, many patients with severe AS do not undergo aortic valve replacement within the year after diagnosis. These patients with severe AS who are managed medically experience high health care-related resource use and costs. Further research is needed to identify factors associated with lack of timely aortic valve replacement and to address barriers to treatment.