Edwards Lifesciences targets NSW Health over lagging access to TAVI in public hospitals

MedTech & Diagnostics News: Aortic valve stenosis has emerged as the most prevalent heart valve disease, aligning with the aging population trends in Australia. Edwards Lifesciences is spearheading an awareness campaign in New South Wales (NSW) to drive the adoption of minimally invasive Transcatheter Aortic Valve Implantation (TAVI).

TAVI has generated a global paradigm shift in treating severe symptomatic aortic stenosis, when compared to the traditional Surgical Aortic Valve Replacement (SAVR). This innovative approach promises patients a quicker recovery time and reduced hospitalisation compared to SAVR, at nearly $10,000 less than open surgery.

“Transcatheter procedures represent a revolution in our approach to aortic stenosis. I expect over the next 5 to 10 years that will extend to other valve conditions,” stated Professor Dion Stub, Interventional Cardiologist at the Alfred Hospital and Western Health in Melbourne, during a recent interview with Health Industry Hub.

Despite being the most populous state, NSW lags behind other states in the adoption of TAVI in public hospital. Statistics reveal that TAVI rates in Victoria, projected to 2027, forecast 1.5 times as many patients per million of population compared to NSW.

Since 1 July 2022, TAVI has been included on the Medical Benefits Scheme (MBS) for patients with symptomatic severe aortic stenosis at low surgical risk, following a positive recommendation by the Medical Services Advisory Committee (MSAC) a year earlier. However, there is inequitable access across the country with NSW Health behind the rest of the country.

According to Prince of Wales Hospital Cardiothoracic Surgeon, Jonathon Ryan “Who should get the last TAVI valve?” is an ethical dilemma that heart teams at many public hospitals routinely grapple with. This is purely a case of economic rationing, where demand exceeds available funding. In contrast, all patients with private health insurance (gold and silver policy holders) are guaranteed access to federally subsidised TAVI.

In a submission to the NSW Special Commission of Inquiry into Healthcare Funding, Edwards Lifesciences expressed concern, stating, “Unfortunately, NSW lags the rest of the country and comparable healthcare systems in adopting TAVI. This capacity-enhancing technology is not being scaled, despite demonstrating improved care processes at the clinical, organisational, and system levels.”

Waiting times for TAVI in NSW vary from 3-4 weeks in the private sector to 6-12 months in the public sector. Edwards Lifesciences estimated that, based on average waiting times, up to 28% of patients in public hospitals will die while awaiting TAVI. In 2022, this translated to between 9 and 59 deaths in NSW.

The Baker Institute’s Our Hidden Ageing: Time to Listen to the Heart whitepaper underscored the importance of early intervention through non-surgical valve replacement, TAVI. It suggested that such measures could prevent productivity losses of up to AUD $117 million in a single year, while patients would gain more than 384,000 Quality-Adjusted Life Years (QALY).

TAVI’s journey in Australia began in 2008 during early clinical trials. The Cardiac Society of Australia and New Zealand, along with the Australia and New Zealand Society of Cardiac and Thoracic Surgeons, have been providing guidance on training requirements. A national TAVI accreditation committee was established to maintain high standards of care, mandating rigorous accreditation processes for hospitals and implanting cardiologists.

Currently, there are 52 TAVI sites, with two more undergoing onboarding. The Australian Transcatheter Valves Therapy Registry (ATVT) has recorded 17,685 cases since its inception in April 2018. A new agreement with South Australian Health and Medical Research Institute (SAHMRI) is set to transform the TAVI registry from a singular entity into a four-valve registry in 2024, incorporating databases for mitral, pulmonary, and tricuspid heart valves.

Alarming research reveals that NSW public hospitals are treating less than 1,000 cases per year, despite approximately 32,000 residents living with severe aortic stenosis in the state. Tragically, over half of these individuals are projected to die within five years without intervention.

The urgent need for increased TAVI adoption in NSW remains a critical focus to save lives and enhance the equitable access to a high standard of care.

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