Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk.

Autor:	Povero M; AdRes Health Economics and Outcomes Research, Turin, Italy, m.povero@adreshe.com., Miceli A; Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy.; Bristol Heart Institute, University of Bristol, Bristol, UK., Pradelli L; AdRes Health Economics and Outcomes Research, Turin, Italy, m.povero@adreshe.com., Ferrarini M; Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy., Pinciroli M; LivaNova, Milan, Italy., Glauber M; Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy.
Jazyk:	angličtina
Zdroj:	ClinicoEconomics and outcomes research : CEOR [Clinicoecon Outcomes Res] 2018 Nov 08; Vol. 10, pp. 733-745. Date of Electronic Publication: 2018 Nov 08 (Print Publication: 2018).
DOI:	10.2147/CEOR.S185743
Abstrakt:	Background: Meta-analyses of studies comparing transcatheter aortic valve implants (TAVIs) and sutureless aortic valve replacement (SU-AVR) show differing effectiveness and safety profiles. The approaches also differ in their surgical cost (including operating room and device). Objective: The objective of this study was to assess the incremental cost-utility of SU-AVR vs TAVIs for the treatment of intermediate- to high-risk patients in the US, Germany, France, Italy, UK, and Australia. Methods: A patient-level simulation compares in-hospital pathways of patients undergoing SU-AVR or TAVIs; later, patient history is modeled at the cohort level. Hospital outcomes for TAVIs reproduce data from recent series; in SU-AVR patients, outcomes are obtained by applying relative efficacy estimates in a recent meta-analysis on 1,462 patients. After discharge, survival depends on the development of paravalvular leak and the need for dialysis. A comprehensive third-party payer perspective encompassing both in-hospital and long-term costs was adopted. Results: Due to lower in-hospital (4.1% vs 7.0%) and overall mortality, patients treated with SU-AVR are expected to live an average of 1.25 years more compared with those undergoing TAVIs, with a mean gain of 1.14 quality-adjusted life-years. Both in-hospital and long-term costs were lower for SU-AVR than for TAVIs with total savings ranging from $4,158 (France) to $20,930 (US). Conclusion: SU-AVR results dominant when compared to TAVIs in intermediate- to high-risk patients. Both in-hospital and long-term costs are lower for SU-AVR than for TAVI patients, with concomitant significant gains in life expectancy, both raw and adjusted for the quality of life. Competing Interests: Disclosure Dr Lorenzo Pradelli is the coowner and an employee of AdRes and has received project funding from LivaNova. Massimiliano Povero is an employee of AdRes and has received project funding from LivaNova. Dr Antonio Miceli, Dr Matteo Ferrarini, and Dr Mattia Glauber are consultants for LivaNova. Matteo Pinciroli is an employee and holds stock options of LivaNova. This study was financially supported by LivaNova. The authors report no other conflicts of interest in this work.
Databáze:	MEDLINE
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