Cost-Effectiveness of Transcatheter Aortic Valve Implantation (TAVI) for High-Risk Patients in Chile

OBJECTIVES: The clinical and economic benefits associated with transcatheter aortic valve implantation (TAVI) have been well-established for European and U.S. high-risk patient populations. This analysis sought to assess the cost-effectiveness of TAVI, compared to surgical aortic valve replacement (SAVR), in high-risk patients from the perspective of the Chilean healthcare system, TAVI was incorporated in 2022 into an extrabudgetary fund aimed at enhancing DRG reimbursement for public healthcare providers.

METHODS: A decision-analytic Markov model, including transitions between three primary health states --alive with no stroke, alive post-stroke, and death –was utilized to project outcomes for both strategies over lifetime. Five-year follow-up from the CoreValve High-Risk Trial (mean age 83.1, 47.2% female) Informed clinical event rates, mortality, utilities, and survival projections for the remaining lifetime. Costs were reported in 2022 CLP and were obtained from activity-based costing and national registries. A 3.5% discount rate was applied to costs and effects. The resulting incremental cost-effectiveness ratio (ICER) was evaluated against one to three times GDP per capita, with the cost-effectiveness threshold ranging from $13,395,069 (highly cost-effective) to $40,185,207 (cost-effective). Extensive sensitivity analyses were explored.

RESULTS: Over lifetime, TAVI added 0.17 QALYs (4.00 vs. 3.83) at increased costs of $6,560,891 ($21,962,615 vs. $15,401,724), resulting in a base case ICER of $38,968,884 per QALY gained and a survival benefit of 0.20 life years. The ICER was most sensitive to assumptions about long-term survival and administrative costs, but remained cost-effective in the majority of scenarios explored.

CONCLUSIONS: This analysis suggests TAVI in high-risk patients is cost-effective, leading to improved outcomes for high-risk patients in the Chilean healthcare system, supporting ongoing activities to fund this intervention. Further analyses should explore TAVI use in a low-risk population to better understand the implications of use in a broader patient population.