Budget Impact Analysis of Transcatheter Aortic Valve Replacement in Low, Intermediate, and High-Risk Patients With Severe Aortic Stenosis in Saudi Arabia

Speaker(s)

Carapinha J1, Al-Omar H2, Alqoofi F3, Samargandy S4, Candolfi P5
1Syenza, Anaheim, CA, USA, 2College of Pharmacy, King Saud University, Riyadh, Saudi Arabia, 3John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia, 4Prince Sultan Cardiac Center, Riyadh, Saudi Arabia, 5Edwards Lifesciences SA, Nyon, VD, Switzerland

OBJECTIVES: A budget impact analysis (BIA) comparing transcatheter aortic valve replacement (TAVR) with SAPIEN 3 and surgical aortic valve replacement (SAVR) for severe, symptomatic aortic stenosis among patients of low, intermediate, and high surgical risk from the perspective of the public and private sectors in Saudi Arabia.

METHODS: A Markov model was developed with 6 states to calculate the budget impact from time of either TAVR or SAVR intervention up to 5 years. We compared the budget effects of new permanent pacemaker implantation (PPI), new onset atrial fibrillation (AF), major/disabling stroke (MDS), and surgical site infections (SSI). One-way sensitivity analyses (OWSA) were performed on cost and probability inputs.

RESULTS: Analysis of the base case parameters suggests TAVR vs. SAVR is budget saving among intermediate and high-risk patients at 5 years. TAVR vs. SAVR for low surgical risk reaches budget neutrality at 5 years. TAVR is associated with higher costs for PPI and budget savings for MDS, AF, and SSI. TAVR also results in savings for non-device costs due to fewer human resource use and shorter procedure durations. Similarly, TAVR is associated with cost savings due to shorter hospital intensive care unit (ICU) and non-ICU stays. Among high-risk patients, TAVR is associated with budget savings (35,653 Saudi Arabian Riyal / 9,498 USD) within 30 days due to length of stay and human resource costs that offset device costs. The OWSA consistently revealed that SAVR non-device theatre costs were the leading cost driver across all surgical risk levels.

CONCLUSIONS: In this study, TAVR with SAPIEN 3 appears to generate savings vs. SAVR from a budget impact perspective across various surgical risk levels in Saudi Arabia. The estimated budget offsets are specific to SAPIEN 3 and were modeled on clinical and costing inputs specific to this technology.

Code

EE367

Topic

Economic Evaluation, Health Policy & Regulatory, Medical Technologies, Methodological & Statistical Research

Topic Subcategory

Budget Impact Analysis, Medical Devices, Reimbursement & Access Policy

Disease

STA: Medical Devices