Cost Effectiveness of Transcatheter Aortic Valve Replacement Compared With Standard Care Among Inoperable Patients With Severe Aortic Stenosis: Results From The PARTNER Trial (Cohort B)
What are the costs and cost-effectiveness of transcatheter aortic valve replacement (TAVR) as compared with standard therapy?
The PARTNER trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgery to TAVR (n = 179) or standard therapy (n = 179). Empirical data regarding survival, quality of life, medical resource use, and hospital costs were collected during the trial and used to project life expectancy, quality-adjusted life expectancy, and lifetime medical care costs in order to estimate the incremental cost-effectiveness of TAVR from a US perspective.
For patients treated with TAVR, mean costs for the initial procedure and hospitalization were $42,806 and $78,542, respectively. Follow-up costs through 12 months were lower with TAVR ($29,289 vs. $53,621) due to reduced hospitalization rates, but cumulative 1-year costs remained higher ($106,076 vs. $53,621). The investigators projected that over a patient’s lifetime, TAVR would increase discounted life expectancy by 1.6 years (1.3 QALYs) at an incremental cost of $79,837. The incremental cost-effectiveness ratio for TAVR was thus estimated at $50,200 per year of life gained or $61,889 per QALY gained. These results were stable across a broad range of uncertainty and sensitivity analyses.
The authors concluded that for patients with severe aortic stenosis who are not candidates for surgery, TAVR increases life expectancy at an incremental cost per life-year gained well within accepted values for commonly used cardiovascular technologies.
This trial-based analysis suggests that the incremental cost-effectiveness ratio for TAVR compared with standard care was estimated at $50,200 per year of life gained or ~$62,000 per QALY gained—results that remained relatively stable across a broad range of uncertainty and sensitivity analyses. Additional studies are indicated to evaluate the cost-effectiveness of TAVR for other lower-risk patient populations, and when compared with other treatment strategies (e.g., surgical AVR). Overall, the current study suggests that TAVR may be a good value in properly selected symptomatic patients with aortic stenosis who are at too high a risk to have surgical AVR.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention
Keywords: Uncertainty, Heart Valve Prosthesis, Hospital Costs, Cost-Benefit Analysis, Follow-Up Studies, Quality of Life, Cardiovascular Diseases, Quality-Adjusted Life Years, Transcatheter Aortic Valve Replacement
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