Machine learning models predict total charges and drivers of cost for transcatheter aortic valve replacement.

Background: Given the increasing healthcare costs, there is an interest in developing machine learning (ML) prediction models for estimating hospitalization charges. We use ML algorithms to predict hospitalization charges for patients undergoing transfemoral transcatheter aortic valve replacement (TF-TAVR) utilizing the National Inpatient Sample (NIS) database.

Methods: Patients who underwent TF-TAVR from 2012 to 2016 were included in the study. The primary outcome was total hospitalization charges. Study dataset was divided into 80% training and 20% testing sets. We used following ML regression algorithms: random forest, gradient boosting, k-nearest neighbors (KNN), multi-layer perceptron and linear regression. ML algorithms were built for for 3 stages: Stage 1, including variables that were known pre-procedurally (prior to TF-TAVR); Stage 2, including variables that were known post-procedurally; Stage 3, including length of stay (LOS) in addition to the stage 2 variables.

Results: A total of 18,793 hospitalization for TF-TAVR were analyzed. The mean and median adjusted hospitalization charges were $220,725.2 ($137,675.1) and $187,212.0 ($137,971.0-264,824.8) respectively. Random forest regression algorithm outperformed other ML algorithms at all stages with higher R score and lower mean absolute error (MAE), root mean squared area (RMSE) and root mean squared logarithmic error (RMSLE) (Stage 1: MAE 79,979.11, R 0.157; Stage 2: MAE 76,200.09, R 0.256; Stage 3: MAE 69,350.09, R 0.453). LOS was the most important predictor of hospitalization charges.

Conclusions: We built ML algorithms that predict hospitalization charges with good accuracy in patients undergoing TF-TAVR at different stages of hospitalization and that can be used by healthcare providers to better understand the drivers of charges.