Aida Ribera1, John Slof2, Rut Andrea3, Carlos Falces3, Enrique Gutiérrez4, Raquel Del Valle-Fernández5, César Morís-de la Tassa5, Pedro Mota6, Juan Francisco Oteo7, Purificació Cascant8, Omar Abdul-Jawad Altisent9, Carlos Sureda9, Vicente Serra9, Bruno García-Del Blanco9, Pilar Tornos9, David Garcia-Dorado9, Ignacio Ferreira-González8. 1. Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: aidaribera@gmail.com. 2. Department of Business, Universitat Autònoma de Barcelona, Spain. 3. Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Spain. 4. Cardiology Department, Instituto de Investigación Sanitaria Gregorio Marañón, Departamento de Medicina, Universidad Complutense, Madrid, Spain. 5. Unidad de Hemodinamica y Cardiología Intervencionista, Area del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain. 6. Servicio de Cardiología, ICICOR, Hospital Clínico Universitario, Valladolid, Spain. 7. Servicio de Cardiología, Hospital Puerta de Hierro, Madrid, Spain. 8. Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain. 9. Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain.
Abstract
OBJECTIVE: To evaluate cost-effectiveness of transfemoral TAVR vs surgical replacement (SAVR) and its determinants in patients with severe symptomatic aortic stenosis and comparable risk. METHODS: Patients were prospectively recruited in 6 Spanish hospitals and followed up over one year. We estimated adjusted incremental cost-effectiveness ratio (ICER) (Euros per quality-adjusted life-year [QALY] gained) using a net-benefit approach and assessed the determinants of incremental net-benefit of TAVR vs SAVR. RESULTS: We analyzed data on 207 patients: 58, 87 and 62 in the Edwards SAPIEN (ES) TAVR, Medtronic-CoreValve (MC) TAVR and SAVR groups respectively. Average cost per patient of ES-TAVR was €8800 higher than SAVR and the gain in QALY was 0.036. The ICER was €148,525/QALY. The cost of MC-TAVR was €9729 higher than SAVR and the QALY difference was -0.011 (dominated). Results substantially changed in the following conditions: 1) in patients with high preoperative serum creatinine the ICERs were €18,302/QALY and €179,618/QALY for ES and MC-TAVR respectively; 2) a 30% reduction in the cost of TAVR devices decreased the ICER for ES-TAVR to €32,955/QALY; and 3) imputing hospitalization costs from other European countries leads to TAVR being dominant. CONCLUSIONS: In countries with relatively low health care costs TAVR is not likely to be cost-effective compared to SAVR in patients with intermediate risk for surgery, mainly because of the high cost of the valve compared to the cost of hospitalization. TAVR could be cost-effective in specific subgroups and in countries with higher hospitalization costs.
OBJECTIVE: To evaluate cost-effectiveness of transfemoral TAVR vs surgical replacement (SAVR) and its determinants in patients with severe symptomatic aortic stenosis and comparable risk. METHODS:Patients were prospectively recruited in 6 Spanish hospitals and followed up over one year. We estimated adjusted incremental cost-effectiveness ratio (ICER) (Euros per quality-adjusted life-year [QALY] gained) using a net-benefit approach and assessed the determinants of incremental net-benefit of TAVR vs SAVR. RESULTS: We analyzed data on 207 patients: 58, 87 and 62 in the Edwards SAPIEN (ES) TAVR, Medtronic-CoreValve (MC) TAVR and SAVR groups respectively. Average cost per patient of ES-TAVR was €8800 higher than SAVR and the gain in QALY was 0.036. The ICER was €148,525/QALY. The cost of MC-TAVR was €9729 higher than SAVR and the QALY difference was -0.011 (dominated). Results substantially changed in the following conditions: 1) in patients with high preoperative serum creatinine the ICERs were €18,302/QALY and €179,618/QALY for ES and MC-TAVR respectively; 2) a 30% reduction in the cost of TAVR devices decreased the ICER for ES-TAVR to €32,955/QALY; and 3) imputing hospitalization costs from other European countries leads to TAVR being dominant. CONCLUSIONS: In countries with relatively low health care costs TAVR is not likely to be cost-effective compared to SAVR in patients with intermediate risk for surgery, mainly because of the high cost of the valve compared to the cost of hospitalization. TAVR could be cost-effective in specific subgroups and in countries with higher hospitalization costs.
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: Bart S Ferket; Jonathan M Oxman; Alexander Iribarne; Annetine C Gelijns; Alan J Moskowitz Journal: J Thorac Cardiovasc Surg Date: 2017-11-15 Impact factor: 5.209