Cost-Effectiveness of Transcatheter Aortic Valve Intervention (TAVI) as Compared with Surgical Aortic Valve Intervention (SAVR) in Swedish Low Risk Aortic Stenosis Patients: Evidence Using Swedeheart Registry Data (2018-2020)

OBJECTIVES: Recent studies have established the cost-effectiveness of TAVI vs. SAVR in the low risk population across several countries. This study aims to assess the cost-effectiveness of TAVI with SAPIEN 3 in the Swedish low risk aortic stenosis (AS) population using all patients in the country from the SWEDEHEART registry (2018-2020) along with Swedish direct healthcare costs and health-related quality of life data.

METHODS: A previously published cost-utility model with a decision tree and a subsequent Markov model structure with four health states was adapted to the Swedish context. Data on short and long-term clinical outcomes and the health states transition probabilities were extracted from the registry for the SAPIEN 3 (n=204) and the SAVR (n=1375) arms. For TAVI, data were additionally extracted for the pooled SAPIEN 3 and SAPIEN 3 Ultra sample (n= 373). For a few outcomes not covered by the registry, data were linked to the National Patient Registry and the outcomes were collected from the ICD-10 codes. Costs were measured in 2022 Swedish Kronas (SEK) and benefits in QALYs gained. The analysis was done from the Swedish Healthcare perspective with a lifetime horizon. Costs and benefits were discounted at 3% annually.

RESULTS: TAVI is a cost-effective alternative as compared with SAVR. With improved QALYs (+0.28) and increased costs (SEK 90 557) per patient for SAPIEN 3 compared with SAVR, the incremental cost effectiveness ratio (ICER) for the base case was SEK 320 642. Model runs with the data on the pooled sample yielded an ICER of SEK 244 549. Results are robust with TAVI remaining cost-effective across multiple sensitivity analyses.

CONCLUSIONS: In this study, TAVI with the latest generation balloon-expandable devices improves outcomes in Swedish low risk AS patients and slightly increases costs. These results are informative for Swedish policy makers as TAVI seems to be a cost-effective treatment option.