The Cost-Effectiveness of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at High Operative Risk

Study Questions:

What is the cost-effectiveness of transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR) in a high-risk aortic stenosis (AS) population?


The authors modeled costs of the two procedures over a 10-year horizon using a Markov model. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curve were calculated with reference to the National Institute of Clinical Excellence (NICE) willingness to pay per quality-adjusted life-year (QALY) gain threshold. Deterministic and probabilistic sensitivity analyses were performed.


TAVI was associated with greater procedural costs compared with SAVR (£16 500 vs. £9,256). Over a 10-year horizon, TAVI was cost-effective compared with SAVR (costs £52 593 vs. £53 943 and QALYs 2.81 vs. 2.75). This was driven by greater postsurgical costs of SAVR, related to the length and cost of hospital stay. The results were robust to a number of deterministic sensitivity and probabilistic analyses. The cost-effectiveness acceptability curve indicated that at the NICE £20 000 willingness to pay threshold per QALY gained, TAVI had a 64.6% likelihood of being cost-effective, compared with 35.4% for SAVR.


The authors concluded that TAVI is likely cost-effective compared with SAVR in high-risk patients with AS.


TAVI is a highly effective therapy in high-risk patients with AS. The results from this and other studies from the United Kingdom mirror the results from the PARTNER trial. The incremental cost-effectiveness ratio for TAVR in patients considered inoperable is estimated at approximately $50,000 per year of life gained (Circulation 2012;125:1102-9). When TAVI was compared with SAVR in the high-risk patients, TAVI was cost-effective when performed via the femoral route, but not when performed via an apical approach (J Am Coll Cardiol 2012;60:2683-92). These studies support the pre-eminence of TAVI as the therapy of choice in high-risk or inoperable AS patients.

Clinical Topics: Cardiac Surgery

Keywords: Heart Valve Prosthesis

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