Transfemoral transcatheter aortic valve replacement compared with surgical replacement in patients with severe aortic stenosis and comparable risk: cost-utility and its determinants

Int J Cardiol. 2015 Mar 1:182:321-8. doi: 10.1016/j.ijcard.2014.12.109. Epub 2014 Dec 27.

Abstract

Objective: To evaluate cost-effectiveness of transfemoral TAVR vs surgical replacement (SAVR) and its determinants in patients with severe symptomatic aortic stenosis and comparable risk.

Methods: Patients were prospectively recruited in 6 Spanish hospitals and followed up over one year. We estimated adjusted incremental cost-effectiveness ratio (ICER) (Euros per quality-adjusted life-year [QALY] gained) using a net-benefit approach and assessed the determinants of incremental net-benefit of TAVR vs SAVR.

Results: We analyzed data on 207 patients: 58, 87 and 62 in the Edwards SAPIEN (ES) TAVR, Medtronic-CoreValve (MC) TAVR and SAVR groups respectively. Average cost per patient of ES-TAVR was €8800 higher than SAVR and the gain in QALY was 0.036. The ICER was €148,525/QALY. The cost of MC-TAVR was €9729 higher than SAVR and the QALY difference was -0.011 (dominated). Results substantially changed in the following conditions: 1) in patients with high preoperative serum creatinine the ICERs were €18,302/QALY and €179,618/QALY for ES and MC-TAVR respectively; 2) a 30% reduction in the cost of TAVR devices decreased the ICER for ES-TAVR to €32,955/QALY; and 3) imputing hospitalization costs from other European countries leads to TAVR being dominant.

Conclusions: In countries with relatively low health care costs TAVR is not likely to be cost-effective compared to SAVR in patients with intermediate risk for surgery, mainly because of the high cost of the valve compared to the cost of hospitalization. TAVR could be cost-effective in specific subgroups and in countries with higher hospitalization costs.

Keywords: Cost-effectiveness; Surgical aortic valve replacement; Transcatheter aortic valve replacement.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / economics
  • Aortic Valve Stenosis / surgery*
  • Cost-Benefit Analysis / methods*
  • Echocardiography
  • Female
  • Femoral Artery
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation / economics
  • Heart Valve Prosthesis Implantation / methods
  • Hospital Costs / trends*
  • Humans
  • Male
  • Prospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Severity of Illness Index
  • Spain / epidemiology
  • Time Factors
  • Transcatheter Aortic Valve Replacement / economics
  • Transcatheter Aortic Valve Replacement / methods*