Health incorporates expensive treatment for heart valve repair

The Ministry of Health will incorporate in the SUS (Unified Health System) a new high-cost technique for the treatment of aortic stenosis.

The incorporation into the SUS Table of the procedure should be published in the coming days in the Official Gazette and was disclosed at the Brazilian Congress of Cardiology, which took place between last Thursday (13) and Saturday (15), in Rio de Janeiro.

Aortic stenosis is a condition characterized by thickening of the aortic valve of the heart and has a higher prevalence in people over 70 years of age. According to data from the Brazilian Society of Cardiology, aortic stenosis has an incidence of 5% in people over 75 years of age.

Until now, the only existing surgery for the treatment of aortic stenosis in the SUS was an open chest surgery to replace the damaged valve with a new one. The surgical procedure, however, carries a high risk of complications, especially in older people, in whom the prevalence of stenosis is higher.

The technique known as Tavi (acronym for percutaneous implantation of the aortic valve) consists of replacing the defective valve by means of a catheter that is inserted into a blood vessel in the patient’s groin area (the femoral artery) and passes through the current blood to the heart, without the need for surgery. In the private network, the procedure costs around R$ 100 thousand.

“If we consider life expectancy today, which is higher than it was 50 years ago, conditions related to aging, such as aortic stenosis, which is calcification of the aortic valve, become more frequent and also more complicated from that age onwards. “, explains Paulo Caramori, scientific director of the Brazilian Society of Cardiology.

The first use of Tavi in ​​Brazil was in 2008, when it was authorized by Anvisa (National Health Surveillance Agency) for patients with aortic stenosis, but its use was restricted to private hospitals. The high cost of the procedure, however, made it impossible to implement it on a large scale in the SUS.

In 2021, an ordinance was published by the Ministry of Health authorizing the incorporation of Tavi into the public network, but conditioned to patients considered inoperable, over 65 years old and in a few surgical centers, especially high complexity hospitals. The evaluation of the procedure also passed through the so-called “cost-effective”, that is, the value of the investment should be lower than the gain in life of the patient, which made approval very rare.

“In the beginning, the incorporation of the technology was not approved due to the high cost, but although this initial cost is high, the absorption of new technologies in the SUS expand its use and consequently it ends up decreasing”, says the cardiologist.

For Caramori, the widespread incorporation of the procedure by the SUS will bring benefits such as reduced post-surgical recovery time and reduced cost.

The doctor considers that the high amount invested at the time of treatment, purchasing the catheter (about R$ 80,000), can be compensated later if you consider other expenses with hospitalization, postoperative and even indirect expenses of the process. “A person who undergoes a surgical procedure has a cost of room and surgical equipment, medical staff, postoperative period and also the companion or family member of that patient, who will need to stay together, not working on those days”, he evaluates.

Also according to the expert, as the use of technology has occurred since 2009, the costs of training health professionals will be minimal. “In some specialized hospital centers, it was already being used, either by a legal action forcing the treatment to be implemented, or by an individual action by the hospital administration. But it is evident that the broader use brings benefits to the population, which will benefit from this technique, and reduces its costs”, he explains.