Expected Economic Savings Associated With Surgical Aortic Valve Replacement Using a Novel Tissue Bioprosthesis: An Update Based on the 7-Year Commence Trial Results
Speaker(s)
Keuffel E1, Reifenberger M2, Marfo G2, Pellegrini A2, Nguyen TC3
1Health Finance and Access Initiative, Bryn Mawr, PA, USA, 2Edwards Lifesciences, Irvine, CA, USA, 3Baptist Health Miami Cardiac & Vascular Institute, Miami, FL, USA
Presentation Documents
OBJECTIVES: Using 7-year data from the COMMENCE trial, this study aims to explore cost implications of a novel aortic tissue versus mechanical valves over a 15-year period.
METHODS: Simulation models estimated disease progression across two hypothetical SAVR cohorts (tissue vs. mechanical) of 10,000 patients in the US over 15 years. The primary comparison calculated health care expenditures associated with each valve type ($US, 2022). Health outcome probabilities and costs were derived from the COMMENCE trial though 7 years and projected for an additional 8 years using peer-reviewed literature. Incidence rates of health outcomes associated with mechanical valves were calculated using relative risks of expected outcomes in tissue valve versus mechanical valve patients.
RESULTS: The expected 15-year savings for a patient receiving tissue SAVR is $22,300 ($US, 2022;95% CI: $17,194–$29,501) relative to mechanical valves. While 30-day and 1-year savings were not statistically significant, expected savings after 7 years are $12,693 (95% CI: $10,090–$16,849). The majority of 15-year savings result from lower anti-coagulation monitoring costs (expected ACM savings: $20,435), but lower bleeding cost (expected bleed reduction savings: $2,229) and thromboembolism-related expenditures (expected savings: $826) also contribute. Expected per patient reoperation costs (Net costs: $604) and endocarditis expenditures (Net costs: $841) were larger in the tissue SAVR cohort. In a sensitivity analysis in which reoperation relative risk reverts from 1.1 to 2.2 (the level in legacy tissue valves) after year 7, aggregate savings are still $17,475.
CONCLUSIONS: Tissue bioprostheses studied in the COMMENCE trial are projected to lower health expenditures relative to mechanical valves and legacy tissue valves through 15 years. The key offsetting factors driving costs are anticoagulation monitoring and reoperation. While this research focuses on the financial implications for payers, patients may also value the quality-of-life benefit and health outcomes associated with these novel tissue valves.
Code
EE344
Topic
Economic Evaluation, Medical Technologies, Study Approaches
Topic Subcategory
Decision Modeling & Simulation, Medical Devices
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Medical Devices, Surgery