TAVI Surgery cost in India

What is TAVI/TAVR Cost in India?

In 2011, India stepped into the future of cardiac care with the first-ever transcatheter aortic valve implantation/replacement (TAVI/TAVR) being performed on an 80 year old patient. Currently, it is being done in around 30 centres across India. It has been suggested that nearly 2.5–3 lakh patients with aortic stenosis are likely to be eligible for transcatheter aortic valve replacement (TAVR).

The average cost of TAVI/TAVR in India ranges between INR 15,00,000 and INR 25,00,000 for Indian patients. For international patients, the cost ranges between USD 28,000 and USD 45,000. This cost includes prosthetic valve price, surgeon fees, anaesthesia charges, OT charges, medical consumables, and a hospital stay for 1-2 days.

What is TAVI?

The heart is the central organ involved in blood circulation. Hence, any complication associated with it impacts the overall functioning of the body. It has flap-like structures, called valves between the heart chambers, which control the blood flow. One of them is an aortic valve, which connects the left ventricle and aorta. It maintains blood circulation to the aorta and ensures that oxygen-rich blood does not flow back into the left ventricle. 

However, sometimes, due to calcification or some genetic causes, the opening of the aortic valve becomes narrow and stiff, thus, limiting its capacity to open completely. This condition is referred to as aortic stenosis arising as a result of following ailments:

Atherosclerosis

This condition arises when plaque, which consists of cholesterol, calcium, and other fatty substances, builds up and hardens inside the arteries. These plaques can partially or completely block blood flow to the heart.

Congenital heart conditions

Some children are born with a two cusped aortic valve instead of three. This bicuspid aortic valve is a hereditary congenital heart defect and can be attributed to genetic mutation or abnormality associated with the DNA sequences.

Infective endocarditis

When bacterial infection reaches the heart via the infected bloodstream, it triggers significant inflammation and symptoms including fevers, chills, and fatigue. This infection can also cause inflammation of the valves, thus, reducing the opening capacity of the aortic valves.

Aortic stenosis usually progresses with age and is characterised by a systolic crescendo-decrescendo murmur. It can be categorised as mild, moderate, severe or critical. Symptoms of Aortic stenosis arise when it becomes severe, which are as follows-

• Persistent chest pain
• Irregular heartbeat
• Shortness of breath
• Feeling of dizziness followed by fainting

Aortic stenosis contributes 2% to the overall heart disease worldwide. If left untreated, it may lead to heart failure.

Hence, to treat aortic stenosis, a highly effective and minimal invasive technique, transcatheter aortic valve implantation (TAVI), is performed. In this, a cardiac surgeon inserts a catheter into the heart and replaces the damaged aortic valve with a prosthetic valve. This treatment procedure is also referred to as transcatheter aortic valve replacement (TAVR).

Based on the artery which is being incised to insert the catheter, a cardiac surgeon adopts some common approaches to perform the TAVI/TAVR procedure which are as follows:

What are the benefits of TAVI over traditional valve replacement procedure?

Traditional methods, such as open-heart surgery, involve repairing or replacing heart valves through a procedure that requires a relatively large incision in the chest. During this surgery, the cardiac surgeon accesses the heart directly and performs the necessary . This approach allows for precise surgical intervention but typically involves a longer recovery period.

TAVR/TAVI, on the other hand, involves a minimal invasive approach to replace the damaged valve with a prosthetic valve. It is made of animal tissue, which can be balloon-expandable, self-expanding, and mechanically expandable. Once the damaged valve is located, the prosthetic valve is inserted there with the help of a catheter, pushing the damaged valve at the back. The catheter is withdrawn once the new valve sets its position and expands so that it can take up the function right away.

What are the Key Factors That Affect the TAVI Cost in India?

Being aware of the cost factors associated with TAVI procedures helps patients and their families avoid financial strain or unexpected expenses. It allows them to plan ahead, explore cost-saving strategies, and mitigate the risk of financial hardship resulting from medical bills or healthcare expenses.

Here, the key factors affecting the TAVR/TAVI cost in India are listed below.

Choice of Valve

The cost associated with the TAVI procedure may vary based on the selection of biological valve type, including options like balloon-expandable valves or self-expanding valves. Some valves may be expensive due to their specific design, materials, or technological features involved in it. The cost of a biological valve for Indian patients is approximately INR 15,00,000. For international patients, the cost is around USD 24000.

Hospital facilities

Hospitals known for their excellent reputation, modern amenities, and top-tier cardiac surgeons tend to have higher fees.

Preoperative medical tests

When aortic stenosis is severe, it often necessitates more comprehensive preoperative evaluations, including advanced imaging and cardiac assessments. These additional diagnostic procedures can extend the TAVI surgery cost in India.

Additional stay at hospital/ICU

In certain medical complexities, the patient may have to stay for some extra days in the hospital or ICU for post-operative care. Thus, the additional hospital stay costs around INR 12,000 and INR 20,000 (USD 200 to USD 300) on a per day basis.

What are the Costs Associated with TAVI Before and After the Procedure?

Before undergoing TAVI, cardiac surgeons recommend various tests and examinations to understand the extent of the damage caused to the aortic valve. After the TAVI procedure, follow ups are necessary to ensure that the prosthetic valve is functioning properly. These expenses should also be considered by the patients and their family.

• Pre-procedural examination cost (complete blood count, electrocardiogram, echocardiogram, coronary angiography, CT scan, nuclear stress test etc.): INR 15,000 to INR 20,000 (USD 250 to USD 300)
• Post-procedural cost (follow-up consultations and medications): INR 3,000 to INR 4,000 (USD 50 to USD 100)

What should be aftercare for a TAVI procedure?

In order to ensure optimal recovery and long-term success of the procedure, monitoring for potential complications such as bleeding, infection, or arrhythmias is essential during the immediate post-operative phase. Some essential aftercare are as follows:

 Incision site care

Though, in TAVI, small incisions are made but utmost care is required to them. The site should not come in contact with any infectious material. Also, the wound should be allowed to heal naturally unless the cardiac surgeon recommends any medication for the same.

Activity restrictions

It is advised to limit strenuous activity such as heavy lifting or strenuous exercise, during the initial recovery period to allow the body to adjust to the changes and heal properly.

Follow-up appointments

It’s recommended that patients should regularly see the cardiac surgeons for every 6 months. If advised, echocardiogram should be done to monitor the functioning of the valve.

Does Insurance Cover TAVI in India?

Insurance agencies in India cover heart surgeries procedures which includes TAVI as well . Once you have been advised for a TAVI by a cardiac surgeon, you have to submit your doctor’s prescription, investigation reports and hospital documents along with your policy papers to the insurance agency. After checking your eligibility for the claim, the insurance agency will then coordinate with the hospital to ensure covering of medical expenses as per policy terms.

Generally, health insurance policies may cover a portion or all of the expenses associated with TAVI. This includes the cost of the prosthetic valve, hospitalisation, surgeon fees, pre-operative tests, and post-operative care.

Hence, it’s also crucial for you to understand the coverage areas and network of hospitals your insurance company is associated with. Otherwise, you may need to bear the remaining costs by yourself or some alternative financial sources.