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

• Published in: International journal of cardiology 2015-03, Vol.182, p.321-328
• Main Authors: Ribera, Aida, Slof, John, Andrea, Rut, Falces, Carlos, Gutiérrez, Enrique, del Valle-Fernández, Raquel, Morís-de la Tassa, César, Mota, Pedro, Oteo, Juan Francisco, Cascant, Purificació, Altisent, Omar Abdul-Jawad, Sureda, Carlos, Serra, Vicente, García-del Blanco, Bruno, Tornos, Pilar, Garcia-Dorado, David, Ferreira-González, Ignacio
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - economics; Aortic Valve Stenosis - surgery; Cardiovascular; Cost-Benefit Analysis - methods; Cost-effectiveness; 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; Surgical aortic valve replacement; Time Factors; Transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - economics; Transcatheter Aortic Valve Replacement - methods
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2014.12.109

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.