BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement (sAVR) for patients at high risk for surgery. OBJECTIVE: To evaluate the safety, effectiveness, and cost-effectiveness of TAVI for treatment of aortic valve stenosis in symptomatic older adults. REVIEW METHODS: A literature search was performed on September 6, 2011, for studies published from January 1, 2007, to September 6, 2011. A combined decision tree and Markov model was developed to compare costs, life years, and quality-adjusted life-years (QALYs) of all treatment options in their respective patient populations over a 20-year time horizon. RESULTS: Two studies from the PARTNER trial were identified. The first study compared TAVI to sAVR in patients who were candidates for sAVR. The second study compared TAVI to standard treatment in patients who were not eligible for sAVR. The first study showed that TAVI and sAVR had similar mortality rates at 1 year. The second study showed a significant improvement in patient survival in those undergoing TAVI. However, in both studies, the TAVI group had significantly higher rates of stroke/transient ischemic attack, and major vascular complications. Rates of major bleeding were significantly higher in sAVR group in the first study and significantly higher in TAVI group in the second study. The base-case cost-effectiveness of TAVI was $48,912 per QALY, but the incremental cost-effectiveness ratio ranged from $36,000 to $291,000 per QALY depending on the assumptions made in the longer-term prediction portion of the model (i.e., beyond the follow-up period of the PARTNER trial). CONCLUSIONS: TAVI improves survival in patients who cannot undergo surgery. For those who are candidates for surgery, TAVI has a mortality rate similar to sAVR, but it is associated with significant adverse effects. TAVI may be cost-effective for patients who cannot undergo surgery, but is not cost-effective for patients who can.
BACKGROUND:Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement (sAVR) for patients at high risk for surgery. OBJECTIVE: To evaluate the safety, effectiveness, and cost-effectiveness of TAVI for treatment of aortic valve stenosis in symptomatic older adults. REVIEW METHODS: A literature search was performed on September 6, 2011, for studies published from January 1, 2007, to September 6, 2011. A combined decision tree and Markov model was developed to compare costs, life years, and quality-adjusted life-years (QALYs) of all treatment options in their respective patient populations over a 20-year time horizon. RESULTS: Two studies from the PARTNER trial were identified. The first study compared TAVI to sAVR in patients who were candidates for sAVR. The second study compared TAVI to standard treatment in patients who were not eligible for sAVR. The first study showed that TAVI and sAVR had similar mortality rates at 1 year. The second study showed a significant improvement in patient survival in those undergoing TAVI. However, in both studies, the TAVI group had significantly higher rates of stroke/transient ischemic attack, and major vascular complications. Rates of major bleeding were significantly higher in sAVR group in the first study and significantly higher in TAVI group in the second study. The base-case cost-effectiveness of TAVI was $48,912 per QALY, but the incremental cost-effectiveness ratio ranged from $36,000 to $291,000 per QALY depending on the assumptions made in the longer-term prediction portion of the model (i.e., beyond the follow-up period of the PARTNER trial). CONCLUSIONS: TAVI improves survival in patients who cannot undergo surgery. For those who are candidates for surgery, TAVI has a mortality rate similar to sAVR, but it is associated with significant adverse effects. TAVI may be cost-effective for patients who cannot undergo surgery, but is not cost-effective for patients who can.
Authors: Menno van Gameren; Nicolo Piazza; Ad J J C Bogers; Johanna J M Takkenberg; A Pieter Kappetein Journal: Heart Date: 2009-12 Impact factor: 5.994
Authors: Alessandro Parolari; Lorenzo L Pesce; Matteo Trezzi; Laura Cavallotti; Samer Kassem; Claudia Loardi; Davide Pacini; Elena Tremoli; Francesco Alamanni Journal: Ann Thorac Surg Date: 2010-03 Impact factor: 4.330
Authors: Maryam Sotoudeh Anvari; Mohammad Ali Boroumand; Abbasali karimi; Mohammad Alidoosti; Parin Yazdanifard; Mahmood Shirzad; Seyed Hesameddin Abbasi; Abbas Soleymani Journal: Arch Med Res Date: 2009-02 Impact factor: 2.235
Authors: Asim M Rafique; Simon Biner; Indraneil Ray; James S Forrester; Kirsten Tolstrup; Robert J Siegel Journal: Am J Cardiol Date: 2009-10-01 Impact factor: 2.778
Authors: Josep Rodés-Cabau; John G Webb; Anson Cheung; Jian Ye; Eric Dumont; Christopher M Feindel; Mark Osten; Madhu K Natarajan; James L Velianou; Giuseppe Martucci; Benoît DeVarennes; Robert Chisholm; Mark D Peterson; Samuel V Lichtenstein; Fabian Nietlispach; Daniel Doyle; Robert DeLarochellière; Kevin Teoh; Victor Chu; Adrian Dancea; Kevin Lachapelle; Asim Cheema; David Latter; Eric Horlick Journal: J Am Coll Cardiol Date: 2010-01-22 Impact factor: 24.094
Authors: Alexander Göhler; Benjamin P Geisler; Jennifer M Manne; Mikhail Kosiborod; Zefeng Zhang; William S Weintraub; John A Spertus; G Scott Gazelle; Uwe Siebert; David J Cohen Journal: Value Health Date: 2008-07-18 Impact factor: 5.725
Authors: James M Brown; Sean M O'Brien; Changfu Wu; Jo Ann H Sikora; Bartley P Griffith; James S Gammie Journal: J Thorac Cardiovasc Surg Date: 2009-01 Impact factor: 5.209
Authors: S Sehatzadeh; B Doble; F Xie; G Blackhouse; K Campbell; K Kaulback; K Chandra; R Goeree Journal: Ont Health Technol Assess Ser Date: 2013-05-01
Authors: Stephen Brecker; Stuart Mealing; Amie Padhiar; James Eaton; Mark Sculpher; Rachele Busca; Johan Bosmans; Ulrich J Gerckens; Peter Wenaweser; Corrado Tamburino; Sabine Bleiziffer; Nicolo Piazza; Neil Moat; Axel Linke Journal: Open Heart Date: 2014-10-23