Economic Evaluation of Transcatheter Versus Surgical Aortic Valve Replacement for Severe Aortic Stenosis in Brazil´s Public Health System: Bridging the Financial Gap.

This study aimed to determine the financial implications of isolated transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in the Brazilian Public Health System (SUS) using time-driven activity-based costing (TDABC). We performed a retrospective observational cohort study at a single center from 2019 to 2022, including 180 patients (TAVR: n = 65; SAVR: n = 115). TAVR patients were older and had higher surgical risk. The total cost of TAVR was significantly higher than SAVR (INT$ 40,776.9 vs INT$ 12,393.7, p <0.001), primarily driven by the prosthetic valve cost. However, TAVR was associated with a shorter postprocedural length of stay (5 days vs 7 days, p <0.001) and lower absolute 1-year mortality rates (3.1% vs 6.1%), although this difference did not reach statistical significance (p = 0.60). Most TAVR cases were accessed through litigation due to the lack of formal incorporation in the public system during the study period, which contributed to higher baseline frailty. In conclusion, while TAVR remains more expensive due to device costs, it offers clinical advantages in high-risk populations within a developing healthcare system.