The cost-effectiveness of transcatheter aortic valve replacement in low surgical risk patients with severe aortic stenosis
| Autor: | Joanna Chikwe, Harindra C. Wijeysundera, Paymon M. Azizi, Derrick Y. Tam, Mario Gaudino, Stephen E. Fremes |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Transcatheter aortic Cost effectiveness Cost-Benefit Analysis medicine.medical_treatment 030204 cardiovascular system & hematology Severity of Illness Index Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Valve replacement Aortic valve replacement Internal medicine medicine Humans 030212 general & internal medicine Stroke Heart Valve Prosthesis Implantation business.industry Health Policy Aortic Valve Stenosis medicine.disease Surgical risk Stenosis Aortic valve stenosis Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal - Quality of Care and Clinical Outcomes. 7:556-563 |
| ISSN: | 2058-1742 2058-5225 |
| Popis: | Aims The economic value of transcatheter aortic valve replacement (TAVR) in low surgical risk patients with severe, symptomatic aortic stenosis is not known. Our objective was to determine the cost-effectiveness of balloon-expandable TAVR and self-expandable TAVR relative to surgical aortic valve replacement (SAVR) in low-risk patients. Methods and results A fully probabilistic Markov cohort model was constructed to estimate differences in costs and effectiveness [quality-adjusted life years (QALYs)] over the patient’s life-time time from the third-party payer’s perspective. Clinical outcomes modelled were alive/well (no complications), permanent stroke, ≥moderate paravalvular leak, new pacemaker, rehospitalization, and death. A network meta-analysis of the PARTNER 3 and Evolut Low Risk trial was performed to compare balloon-expandable TAVR, self-expandable TAVR, and SAVR for the efficacy inputs. Incremental-cost effectiveness ratios (ICER) were calculated. The total life-time costs in the balloon-expandable TAVR, self-expandable-TAVR, and SAVR arms were $37 330 ± 4724, $39 660 ± 4862, and $34 583 ± 6731, respectively, and total life-time QALYs gained were 9.15 ± 3.23, 9.13 ± 3.23, and 9.05 ± 3.20, respectively. The ICERs for balloon-expandable TAVR and self-expandable TAVR against SAVR were $27 196/QALY and $59 641/QALY, respectively. Balloon-expandable TAVR was less costly and more effective than self-expandable TAVR. There was substantial uncertainty, with 53% and 58% of model iterations showing balloon-expandable TAVR to be the preferred option at willingness-to-pay thresholds of $50 000/QALY and $100 000/QALY, respectively. Conclusion Compared with SAVR, TAVR, particularly with balloon-expandable prostheses may be a cost-effective option for patients with severe aortic stenosis at low surgical risk. |
| Databáze: | OpenAIRE |
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