Analysis of TAVR Finds Transfemoral Approach More Cost-Effective Than Surgery

Results of a prospective economic analysis of transcatheter aortic valve replacement (TAVR) performed in patients with severe aortic stenosis indicate that the procedure is slightly more cost-effective and provides a modest benefit in quality-adjusted life expectancy compared with surgical aortic valve replacement when the transcatheter procedure is performed through transfemoral access rather than transapical access, according to a study published Dec. 17 in the Journal of the American College of Cardiology.

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The study analyzed costs associated with the treatment of 647 patients with severe asymptomatic aortic stenosis enrolled in the Placement of Aortic Transcatheter Valves Cohort A (PARTNER Cohort A) trial and randomized to either transcatheter or surgical aortic valve replacement. The transcatheter patients were further separated into a transfemoral cohort and transapical cohort. Overall, the trial found that transcatheter and surgical aortic valve replacement procedures performed for these patients produced similar results in terms of costs over 12 months and quality-adjusted life years. However, when the analysis was stratified by transcatheter access site, the patients treated through the femoral artery rather than through the apex of the left ventricle had a modest benefit in quality-adjusted life expectancy and slightly reduced costs compared with the patients treated surgically. The cost savings was approximately $1,250 per patient treated. 

The study, which is the first to evaluate the cost-effectiveness of transcatheter vs. surgical aortic valve replacement among patients who are candidates for high-risk surgical aortic valve replacement, suggests that TAVR is an economically attractive strategy compared with surgical aortic valve replacement for patients suitable for treatment through transfemoral access.

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