Praveen Indraratna1, Su C Ang1, Hemal Gada2, Tristan D Yan3, Con Manganas4, Paul Bannon3, Christopher Cao5. 1. Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia. 2. Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia. 3. Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 4. Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia. 5. Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia. Electronic address: drchriscao@gmail.com.
Abstract
OBJECTIVE: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment to aortic valve replacement (AVR) for selected patients with severe aortic stenosis. The present systematic review was conducted to analyze the cost-effectiveness of this novel technique within reimbursed healthcare systems. METHODS: Two reviewers used 7 electronic databases from January 2000 to November 2012 to identify relevant cost-effectiveness studies of TAVI versus AVR or medical therapy. The primary endpoints were the incremental cost-effectiveness ratio (ICER) and the probability of cost-effectiveness. The eligible studies for the present systematic review included those in which the cost-effectiveness data were measured or projected for TAVI and either medical therapy or AVR. All forms of TAVI were included, and all retrieved publications were limited to the English language. RESULTS: Eight studies were included for quantitative assessment. The ICER for TAVI compared with medical therapy for surgically inoperable patients ranged from US$26,302 to US$61,889 per quality-adjusted life year gained. The probability of TAVI being cost-effective compared with medical therapy ranged from 0.03 to 1.00. The ICER values for TAVI compared with AVR for high-risk surgical candidates ranged from US$32,000 to US$975,697 per quality-adjusted life year gained. The probability of TAVI being cost-effective in this cohort ranged from 0.116 to 0.709. CONCLUSIONS: Depending on the ICER threshold selected, TAVI is potentially justified on both medical and economic grounds compared with medical therapy for patients deemed to be surgically inoperable. However, in the high-risk surgical patient cohort, the evidence is currently insufficient to economically justify the use of TAVI in preference to AVR.
OBJECTIVE: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment to aortic valve replacement (AVR) for selected patients with severe aortic stenosis. The present systematic review was conducted to analyze the cost-effectiveness of this novel technique within reimbursed healthcare systems. METHODS: Two reviewers used 7 electronic databases from January 2000 to November 2012 to identify relevant cost-effectiveness studies of TAVI versus AVR or medical therapy. The primary endpoints were the incremental cost-effectiveness ratio (ICER) and the probability of cost-effectiveness. The eligible studies for the present systematic review included those in which the cost-effectiveness data were measured or projected for TAVI and either medical therapy or AVR. All forms of TAVI were included, and all retrieved publications were limited to the English language. RESULTS: Eight studies were included for quantitative assessment. The ICER for TAVI compared with medical therapy for surgically inoperable patients ranged from US$26,302 to US$61,889 per quality-adjusted life year gained. The probability of TAVI being cost-effective compared with medical therapy ranged from 0.03 to 1.00. The ICER values for TAVI compared with AVR for high-risk surgical candidates ranged from US$32,000 to US$975,697 per quality-adjusted life year gained. The probability of TAVI being cost-effective in this cohort ranged from 0.116 to 0.709. CONCLUSIONS: Depending on the ICER threshold selected, TAVI is potentially justified on both medical and economic grounds compared with medical therapy for patients deemed to be surgically inoperable. However, in the high-risk surgical patient cohort, the evidence is currently insufficient to economically justify the use of TAVI in preference to AVR.
Authors: Aida Ribera; John Slof; Ignacio Ferreira-González; Vicente Serra; Bruno García-Del Blanco; Purificació Cascant; Rut Andrea; Carlos Falces; Enrique Gutiérrez; Raquel Del Valle-Fernández; César Morís-de laTassa; Pedro Mota; Juan Francisco Oteo; Pilar Tornos; David García-Dorado Journal: Eur J Health Econ Date: 2017-11-23
Authors: Jochen Reinöhl; Klaus Kaier; Anja Gutmann; Stefan Sorg; Constantin von Zur Mühlen; Matthias Siepe; Hardy Baumbach; Martin Moser; Annette Geibel; Andreas Zirlik; Philipp Blanke; Werner Vach; Friedhelm Beyersdorf; Christoph Bode; Manfred Zehender Journal: BMC Cardiovasc Disord Date: 2015-10-22 Impact factor: 2.298
Authors: Klaus Kaier; Anja Gutmann; Hardy Baumbach; Constantin von Zur Mühlen; Philip Hehn; Werner Vach; Friedhelm Beyersdorf; Manfred Zehender; Christoph Bode; Jochen Reinöhl Journal: Health Qual Life Outcomes Date: 2016-07-26 Impact factor: 3.186