MBS listing of TAVI expands access for all patients with severe aortic stenosis

From July 1, 2022, transcatheter aortic valve implantation (TAVI) will be funded on the Medical Benefits Scheme (MBS) for patients with symptomatic severe aortic stenosis (AS) at low surgical risk, 12 months after it was positively recommended by the Medical Services Advisory Committee (MSAC).

Since its introduction more than a decade ago, TAVI has emerged as the clinical standard of care in the public and private setting for high-risk surgical patients with severe aortic stenosis. However, multiple studies reveal TAVI also has greater short- and long-term benefits for low-risk patients, compared with surgical aortic valve replacement (SAVR).

According to Dr Ronen Gurvitch, Interventional Cardiologist and TAVI specialist at the Royal Melbourne Hospital and One Heart Cardiology, Melbourne, the MBS listing effectively expands access to minimally invasive, non-surgical treatment options for all severe AS patients.

“The treatment paradigm for AS has shifted. Traditionally, TAVI was only available to the oldest and frailest patients deemed too high risk to survive open heart surgery. However, data supports the use of TAVI as a therapy option for all patients with severe aortic stenosis,” said Dr Gurvitch.

“TAVI offers significant benefits over surgery, including reduced procedure time, less time in hospital, a shorter recovery period, lower risk of complications, improved quality of life, and extended life expectancy.

“Among severe symptomatic aortic stenosis patients, TAVI results in 46 per cent lower rates of death, stroke and re-hospitalisation within the first year of the procedure, compared to SAVR.

Data at two years following TAVI shows continued superiority over surgery, with 34 per cent lower rates of death, stroke, and rehospitalisation,” Dr Gurvitch said.

“The MBS expansion of TAVI will better facilitate shared decision-making between Heart Team and their severe AS patients, enabling us to choose the most suitable treatment based on anatomical factors, latest clinical evidence and patient preferences.

The rate of severe aortic stenosis is increasing in Australia, with more than 97,000 Australians estimated to be living with the disease,11 and an additional 10,000 predicted to be affected each year.

The survival rate of untreated severe AS is worse than many metastatic cancers, including lung, colorectal, breast, ovarian and prostate cancers.13 If not identified, or treated, more than 50 per cent of those with severe aortic stenosis may die within two years once symptoms appear.

Dr Gurvitch says aortic stenosis is both under-diagnosed and under-treated in Australia. “Recent Australian data suggests that approximately 90 per cent of patients with aortic stenosis are
not receiving treatment.

This is often because those living with aortic stenosis may not experience any noticeable symptoms until their blood flow is severely restricted,16 by which stage common symptoms of the disease are often wrongly attributed to the aging process,” said Dr Gurvitch.

“The risk of developing the disease increases with age, with those aged 65 years and above most affected. As such, cardiac auscultation should form part of an annual GP comprehensive cardiovascular disease risk assessment for every Australian over 65 years of age.

“Patients found to have any abnormalities should be referred to a cardiologist for further examination including echocardiography – the test of choice for heart valve disease,” Dr Gurvitch said.

CEO and founder of Hearts4heart, Tanya Hall, Melbourne, welcomes the additional MBS item but believes more needs to be done to address the nation’s rising rates of undiagnosed heart valve disease.

“The availability of TAVI on Medicare means that all patients with severe forms of AS now have access to a minimally invasive, non-surgical approach to aortic valve replacement, improving patient choices,” said Ms Hall.

“However, the number of people living with aortic stenosis in Australia predicted to increase over the next 30 years, particularly among those aged over 75 years, placing a significant burden on Australia’s healthcare system and economy, given our ageing population.

“Offering minimally invasive treatments, such as TAVI, to more people aged 65 years and over, could save the public purse AUD 117 million per annum,” Ms Hall said.

“Heightening awareness among older Australians to increase patient identification, and subsequent treatment is a critical first step, which is why we are also advocating for cardiac auscultation to be added to the existing heart check MBS item this year.”

According to a recent Baker Heart and Diabetes Institute whitepaper, urgent attention is required to address the nation’s rising rates of undiagnosed heart valve disease.

This includes the clinical screening of heart valve disease as part of a routine health and wellness evaluation for older Australians, improving access to echocardiography to encourage GPs to further investigate abnormalities relating to heart valve disease, and implementing national guidelines for heart valve disease that present a clear management pathway from diagnosis to treatment, which physicians can utilise as protocols for decision-making.

The new MBS item 38522 will be introduced from July 1, 2022 for the lower-risk patient cohort, with administrative amendments to items 38495 and 38514. To learn more about TAVI, head to heartvalves.com.au.

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TAVI now available on Medicare for more patients living with severe aortic stenosis