Case 2010-MDC05-01 Transcatheter Aortic Valve Implantation (TAVI)
|Target version:||Expert Group 2011|
|MDC:||MDC05||Owner / responsible:|
|Target Grouper:||COMMON, DEN, EST, FIN, ICE, LAT, NOR, SWE||Old forum status:|
Last updated: 2011-04-20
Status: CLOSITEM - Closed item
By: Laura Lüdtke (firstname.lastname@example.org), Carole Cohen (Carole_Cohen@edwards.com),
Svangren, Per (email@example.com)/CPK, Sweden
Expert Network 2010-03-13 - Postpone recommended
Board 2010-04-09 - Recommendation accepted
Expert Network 2011-03-17 - Change recommended
Board 2011-04-04 - Recommendation accepted
CPK ID 298
FMD12 (Percutaneous transluminal replacement of aortic valve using biological prosthesis) and FMD13 (Percutaneous transapical replacement of aortic valve using biological prosthesis) are relatively new procedures to replace the aortic valve. The codes were introduced in NCSP 2009.
The percutaneous approach means that there is no need for thoracotomy or extracorporeal circulation and the operation can be performed under local anaesthesia. This means that also high risk patients can be operated.
According to the present DRG logic FMD12 and FMD13 are grouped to DRG 104A (Single heart valve operations) or, if any CC factor is registered, DRG 104B (Multiple heart valve operations or single valve operations w CC). Cases with FMD12/FMD13 are much more expensive than the other cases in DRG 104A/104B, however, and a separate DRG for cases with FMD12/FMD13, like in the Danish DRG system, is proposed.
Analysis by CPK
The analysis was not possible to do on the latest Swedish cost data base from 2008 since the codes FMD12 and FMD13 were introduced 2009. Therefore we collected data for January - September 2009 directly from the hospitals that perform these procedures. Data from the Karolinska Hospital contained the patients’ age and supports that the procedures are performed on elderly patients. The age of the Karolinska patients varied between 69-91 years and the mean age was 85 years. According to the Karolinska material 30 out of the total 39 patients were not cost outliers.
All the hospitals, except Uppsala, could provide KPP data. The material is presented in the table below. (The original tables contained also data from 2008 but these posts have been excluded.)
The material is summarized in the following table.
According to data from ¾ of the year 2009 the total number of patients per year is approximately 100 today but the percutaneous approach in replacement of aortic valves will certainly be more frequent in the future.
With the present DRG logic these patients will be grouped to DRG DRG 104A or, if any CC factor is registered, DRG 104B. Data from the Karolinska Hospital contained the patients’ DRG code and according to that data 28 of the 39 patients (72 %) were grouped to DRG 104B.
The following table shows cost data for DRG 104A and 104B in the Swedish cost database for 2008 (cost outliers excluded).
Are the criteria for creating a new DRG fulfilled? Compared to the mean cost for DRG 104A the FMD12/FMD13 patients are 68 % more expensive and compared to the mean cost for DRG 104B they are 17 % more expensive. If we construct a DRG for patients with FMD12/FMD13 we can assume that at least 100 patients will be transferred from DRG 104A/104B to the new DRG, which is approximately 5 % of the patients.
Summary by CPK
Our analysis supports that patients with FMD12/FMD13 are more expensive than other patients in DRG 104A/104B and the criteria for creating a new DRG (split) are more or less fulfilled.
Recommendation by CPK
A new DRG is constructed for patients with FMD12/FMD13 in NordDRG 2011 in accordance with the Danish DRG.
Expert Network 2010-03-12
The meeting recommended postponing the case for further investigation and analysis by Sweden, Finland and Norway. New investigation the autumn 2010 with current costs data. Is this changed a request from the profession?
See usefull links from Norway:
Martti Virtanen 2010-08-26
The Swedish hospitals need a solution for this problem for 2011. Therefore we have now created a model that solves the problem. Sweden will report on the results for development of NordDRG 2012.
A new DRG 104C ‘Transcatheter Aortic Valve Implantation (TAVI)’ is created.
A new procedure property 05S80 ‘Transcatheter Aortic Valve Implementation’ is created and given to procedures FMSD12 and FMSD13.
A new rule is implemented after 104B before 104A (currently ord 405D031000). It is a copy of rule for 104A (405D031002) but DRG is changed to 104C and procpro1 to 05S80.
Cases with the procedures at issue (in MDC 5) and without more resource needing procedures (like multiple valve operations) are assigned to the new DRG 104C.
NordDRG Sweden 2011
Expert Network 2011-03-17
The meeting recommended acceptance of this solution and introduce it in all versions and move DRG 104C higher up before DRG 104B.
The case will be closed.
Technical change 2011-03-28
New procedure property 05S80 ‘Transcatheter Aortic Valve Implantation’-
FMSD12 ’Percutaneous transluminal replacement of aortic valve using biological prosthesis’ and FMSD13 ‘Percutaneous transapical replacement of aortic valve using biological prosthesis’ (and linked national codes) are given new property 05S80.
A new rule is added to the logic table immediately before the current line 405D02201 (in Swedish version the current line 405D031000 is moved to this position).
DRG is given value 104C, ICD +, MDC 05, OR S, procpro1 05S80, rtc 0.
DRG-names 104C Transcatheter Aortic Valve Implantation (TAVI).
DRG change 2011-03-28
Cases with the listed procedures are assigned to DRG 104C even if multivalvular procedures are performed.