The Effect of Hospital Market Competition on the Adoption of Transcatheter Aortic Valve Replacement

Abstract Background The use of transcatheter aortic valve replacement (TAVR) has grown rapidly. The purpose of this study was to assess whether hospital market competition was associated with the use of TAVR. Methods We used five Healthcare Cost and Utilization Project state inpatient databases (AZ, FL, IA, MA, WA) to identify patients undergoing TAVR (n=5,563) or surgical aortic valve replacement (SAVR; n=30,672) across 154 hospitals from 2011-2014. Using the Herfindahl-Hirschman Index (HHI) to calculate market competition, hospitals were categorized into commonly-used categories of low (HHI > 0.25), moderate (HHI 0.15-0.25), and high (HHI Results After adjustment, patients treated at high competition hospitals had higher odds of receiving TAVR, relative to patients at low competition hospitals (ORadj: 5.31, 95% CI: 2.10-13.4). TAVR use increased each year (ORadj: 1.73, 95% CI: 1.38-2.17), but was similar across HHI categories. Competition was not associated with in-hospital mortality or LOS. Patients at high competition hospitals were more likely to be discharged home (ORadj: 2.39, 95% CI: 1.23 - 4.66) compared to low competition hospitals. Conclusions Market competition was positively associated with a hospital’s adoption of TAVR. Future studies should further examine the impact of competition on quality and appropriateness.