Background

Transcatheter aortic valve implantation (TAVI) for aortic stenosis in older patients is the standard of care with a well-established supply density in Germany. In the near future, healthcare reform is planned that may affect TAVI capacities. Therefore, it is important to know how political regulations may interfere with access to services and what the need for TAVI will be in the future, based on demographic trends.

Methods

The number of TAVI procedures (DRG F98A +F98) and the in-hospital main diagnoses of aortic stenosis (ICD I35) in 2021 were analyzed at the level of county or federal state based on anonymized data from hospital reports, according to § 21 of the German hospital reimbursement law. The number of TAVI and aortic stenosis cases was projected for 2035 based on data from the German Federal Statistical Office on demographic developments. With quality assurance data from hospitals in 2019 and a route planner, the travel time to the next hospital performing TAVI (OPS 5‑35a.0) was calculated, and the consequence of a politically suggested minimum volume cut-off was analyzed.

Results

In 2021, a total of 26,506 TAVI procedures were reported with a mean number of TAVI per 100,000 inhabitants of 32 (range between federal states from 25 to 42). Among the 66,045 diagnoses of aortic stenosis, there was a variation per 100,000 inhabitants from 64 to 108 (mean 79) between federal states. Compared to 2021, an additional 8748 (+13%) diagnoses of aortic stenosis and an increase of 4673 (+18%) TAVI procedures is to be expected in 2035. In 2019, 57% of German citizens could reach a TAVI hospital within 30 min and 91% within 60 min of driving time by car (mean time to hospital 31 min). Applying a minimum number of 150 TAVI/hospital per year would increase the driving time to hospital from 33 to 52 min in Saxony-Anhalt and instantly remove six out of eight hospitals from service in Hesse.

Conclusion

Regulation of TAVI services by minimum volume numbers would arbitrarily interfere with access to services, in contradiction to the medical service assurance tasks of federal state governments. These issues should be considered in the upcoming healthcare system reform.

中文翻译：

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德国经导管主动脉瓣植入术的医疗保健提供

背景

针对老年主动脉瓣狭窄患者的经导管主动脉瓣植入术 (TAVI) 是标准治疗方法，在德国拥有完善的供应密度。在不久的将来，计划进行的医疗改革可能会影响 TAVI 的能力。因此，根据人口趋势，了解政治法规如何干扰服务获取以及未来对 TAVI 的需求非常重要。

方法

根据医院报告第 21 条，根据医院报告的匿名数据，在县或联邦州一级对 2021 年 TAVI 手术数量 (DRG F98A +F98) 和院内主要诊断的主动脉瓣狭窄 (ICD I35) 进行了分析。德国医院报销法。根据德国联邦统计局的人口发展数据，预计 2035 年 TAVI 和主动脉瓣狭窄病例数。利用 2019 年医院的质量保证数据和路线规划器，计算了前往下一家进行 TAVI (OPS 5-35a.0) 的医院的行程时间，并分析了政治建议的最小交通量截止的后果。

结果

2021 年，总共报告了 26,506 例 TAVI 手术，每 10 万居民中 TAVI 的平均数量为 32 个（联邦州范围为 25 至 42 个）。在 66,045 例主动脉瓣狭窄诊断中，各联邦州之间每 100,000 名居民中有 64 例到 108 例（平均 79 例）不等。与 2021 年相比，预计到 2035 年，主动脉瓣狭窄诊断将增加 8748 例（+13%），TAVI 手术将增加 4673 例（+18%）。2019 年，57% 的德国公民可以在 30 年内到达 TAVI 医院。分钟，91% 在开车 60 分钟内（平均到医院时间 31 分钟）。每年每家医院至少应用 150 辆 TAVI 将使萨克森-安哈特州前往医院的驾驶时间从 33 分钟增加到 52 分钟，并立即使黑森州八家医院中的六家停止服务。

结论

通过最低数量对 TAVI 服务进行监管将任意干扰服务的获取，这与联邦政府的医疗服务保障任务相矛盾。这些问题应该在即将到来的医疗体制改革中得到考虑。