Characterizing the “iceberg peak” in valvular heart disease: Outcomes and costs of in-hospital procedures in Spain

Introduction and objectives

The aim was to describe the burden of disease of valvular heart disease (VHD) in-hospital interventions in Spain.

Methods

The analysis involved all cases between 2016 and 2019 in the Spanish Ministry of Health database under the International Classification of Diseases 10th Revision. Procedure rates by region and year (×10⁶), patient risk profile (comorbidities), health outcomes (death), length of stay (LoS), and costs were examined.

Results

A total of 57 878 procedures were analyzed, representing a national rate from 292 in 2016 to 321 in 2019 (×10⁶ inhabitants). Comorbidities measured by the age-adjusted Charlson Comorbidity Index ranged between 3.47 and 3.77 and increased over the period. The in-hospital complications have remained constant over the years with some exceptions. Death rate (×10⁶ inhabitants) was 18.0, and the in-hospital mortality per year range was statistically constant and between 5.23% and 6.20%. The unadjusted LoS ranged from 14.68 to 15.34 days (standard deviations [SD], 16.03 and 15.79) including 2.68 to 3.27 days (SD, 6.57–7.82) in the intensive care unit. VHD procedures costs amounted to €1403.13 million in the period, representing an annual cost of €350.8 million. These costs decreased by 3.17% over the period. Per-procedure mean cost also decreased from €24 801.81 (SD, €10 231.91) to €24 015.50 (SD, €9825.39).

Conclusions

VHD entails a large and increasing volume of procedures in Spain. While a decline in the per-procedure mean cost was noted, the overall annual cost increased. This underscores the substantial burden on the national health system, even when considering solely in-hospital procedures.