Long-term Healthcare Expenditures Over Time for Tissue and Mechanical Aortic Valve Replacement
| Autor: | Eric L Keuffel, Matt Moore, Candace Gunnarsson, Tom C. Nguyen, Tara Walker |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Time Factors Cost-Benefit Analysis 030204 cardiovascular system & hematology Health outcomes Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Aortic valve replacement Risk Factors Health care Medicine Humans Aged business.industry Mechanical Aortic Valve Aortic Valve Stenosis Health Care Costs Middle Aged medicine.disease Confidence interval Stenosis 030228 respiratory system Relative risk Aortic Valve Heart Valve Prosthesis Replantation Emergency medicine Surgery Female Quality-Adjusted Life Years Health Expenditures Cardiology and Cardiovascular Medicine business Cohort study Follow-Up Studies |
| Zdroj: | The Annals of thoracic surgery. 112(2) |
| ISSN: | 1552-6259 |
| Popis: | Background Guidelines currently indicate the use of surgical aortic valve replacement (SAVR) to treat severe cases of aortic stenosis, particularly for low- to medium-risk patients. Although several studies have compared health outcomes of tissue and mechanical SAVR, this economic simulation model estimates the difference in long-term healthcare costs associated with tissue relative to mechanical SAVR. Methods The deterministic and Monte Carlo simulation models used literature-based epidemiologic and cost inputs to calculate annual expenditures related to SAVR for up to 25 years after initial surgery. A series of 3 cohort studies across different age groups provided the health outcome probabilities for tissue valve patients. Outcome probabilities for mechanical valve patients were based on relative risks reported in comparative meta-analyses or large cohort studies. Results Relative to mechanical SAVR the expected net discounted savings for a patient receiving tissue SAVR at ages 45, 55, and 65 years were $12,266, $15,462, and $16,008, respectively (based on 2018 US dollars) over a 25-year horizon (95% confidence intervals exceed $0). For a 45-year-old tissue SAVR patient, the estimated per-patient cost difference (relative to mechanical SAVR) of reoperation over 25 years ($16,201) were offset by expected savings on anticoagulation monitoring ($26,257) over the same period. In a sensitivity analysis in which mortality risk was assumed equal, significant long-term savings associated with tissue SAVR still accrued in each of the 3 age cohorts. Conclusions Payers, providers, and the healthcare system may financially benefit from the use of tissue valves because significant savings were associated with the use of tissue valves relative to mechanical valves for SAVR. |
| Databáze: | OpenAIRE |
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