Omer et al1 in this issue of JAMA Surgery provide insight into the introduction of the SAPIEN transcutaneous aortic valve (Edwards Life Sciences) into a national health care system capable of tracking both procedural outcomes and long-term costs. The Veterans Affairs (VA) health care system is a new frontier for the use of transcatheter aortic valve replacement (TAVR) therapy. The VA patient population is diverse and complex, and the introduction of new technologies is strictly managed. As an alternative to surgical or medical therapy, TAVR provides a treatment option for patients determined to have unacceptably high, or prohibitive, operative mortality risk. There is a cohort of poor surgical candidates in this VA population for whom TAVR will be the only option for aortic valve disease treatment, and they deserve state-of-the-art technology. This study illustrates optimal implementation of an expensive new technique in a system with limited health care dollars.
Kelly RF, Mudy K. The VA Advantage for Appropriate TAVR Use. JAMA Surg. 2013;148(12):1093–1094. doi:10.1001/jamasurg.2013.3719