Results from an economic analysis of data from PARTNER 3, as well as data highlighting five-year clinical and echocardiographic outcomes from the SURTAVI trial, continue to add to the body of evidence surrounding use of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in different patient groups. Findings from both trials were part of a Late-Breaking Clinical Trial session at TCT 2021 on Nov. 5.

While previous studies have shown TAVR is cost-effective compared with SAVR in patients at intermediate or high risk, the PARTNER 3 economic analysis is among the first to look at whether TAVR is cost-effective for low-risk patients. David J. Cohen, MD, MSc, and colleagues assessed costs associated with 979 patients in the U.S. who underwent either TAVR or SAVR between March 2016 and October 2017 using a combination of resource utilization associated with the initial TAVR or SAVR procedures and linked Medicare claims for all other costs over two years.

Results found index hospitalization costs were $47,196 for TAVR and $46,606 for SAVR, while follow-up costs between hospital discharge and the two years were less for TAVR ($19,638) compared with SAVR ($22,258). Overall, the total combined two-year cost was $66,834 for TAVR compared with $68,864 for SAVR – a difference of $2,030.

Researchers also noted that two-year quality-adjusted life expectancy was greater with TAVR than SAVR (1.71 vs. 1.66 quality-adjusted life years, p=0.06), largely driven by early benefits in both quality of life and survival. Although long-term outcomes remain unknown at this time, Cohen and colleagues project TAVR has a 95% probability of being cost-effective compared with SAVR. They note that additional studies over the next 10 years are necessary.

“Data from the PARTNER 3 trial show that for patients with severe aortic stenosis and low surgical risk, TAVR is cost-saving compared with SAVR at two-year follow-up and is projected to be highly cost effective over a lifetime horizon – as long as there are no major differences in late mortality between the two strategies,” said Cohen.

Meanwhile, results from the SURTAVI trial, while not economic in nature, showed no significant difference in the primary composite endpoint of all-cause mortality or stroke at five years following TAVR or SAVR in patients at intermediate risk, according to Nicolas M. Van Mieghem, MD, PhD, FACC.

In other findings, researchers observed more reinterventions following TAVR in the first two years. However, these rates were similar across both groups after the two-year mark. Key clinical outcomes, including any stroke, myocardial infarction, valve endocarditis and valve thrombosis, were also similar across both groups after two years. Researchers did note that TAVR had significantly better forward-flow hemodynamics than surgery at each follow-up (all p<0.001), but paravalvular leak was significantly better with surgery at each follow-up (all p<0.001).

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging

Keywords: Transcatheter Cardiovascular Therapeutics, TCT21, Transcatheter Aortic Valve Replacement, Aortic Valve Stenosis, Heart Valve Prosthesis Implantation, Angiography

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