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

Aida Ribera, John Slof, Rut Andrea, Carlos Falces, Enrique Gutiérrez, Raquel Del Valle-Fernández, César Morís-De La Tassa, Pedro Mota, Juan Francisco Oteo, Purificació Cascant, Omar Abdul Jawad Altisent, Carlos Sureda, Vicente Serra, Bruno García-Del Blanco, Pilar Tornos, David Garcia-Dorado, Ignacio Ferreira-González

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23 Citations (Scopus)

Abstract

© 2014 Elsevier Ireland Ltd. All rights reserved. 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.
Original languageEnglish
Pages (from-to)321-328
JournalInternational Journal of Cardiology
Volume182
DOIs
Publication statusPublished - 1 Mar 2015

Keywords

  • Cost-effectiveness
  • Surgical aortic valve replacement
  • Transcatheter aortic valve replacement

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