Economic Evaluation of Transcatheter Versus Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients with Severe Aortic Stenosis in China

OBJECTIVES: Transcatheter aortic valve replacement is an alternative to surgery in patients with severe aortic stenosis who are at intermediate- and low-risk. There is no economic evaluation study on TAVR in China, whether TAVR is cost-effective compared to SAVR in China is uncertain. We aimed to evaluate the economic burden and effectiveness of TAVR compared to SAVR in low-and intermediate-risk AS patients in China, including risk, age, and valve type subgroups.

METHODS: A decision-analytic model was constructed to compare cost-effectiveness of different treatment strategies from the Chinese healthcare system’s perspective. Model inputs were derived from published literatures, real-world data, our own Meta-analysis results. The model simulated a hypothetical cohort of low- and intermediate-risk patients (STS≤8%) with severe AS who underwent only AVR during hospitalization. Outcomes included total costs, QALYs, ICER, subgroup and sensitivity analyses were performed to examine robustness of the model results.

RESULTS: In the base-case analysis, the total lifetime costs after discounting were $28,042.77, $58,777.59, for SAVR, TAVR groups, respectively. 5.9 QALYs, 6.52 QALYs were gained for SAVR, SAVR respectively. In the low-risk population, TAVR was more expensive than SAVR at an incremental cost of $30,810.09 and was associated with benefits of 1.04 QALYs lived over a lifetime horizon. This yielded an ICER of $29,542.6/QALY, which fell below the predetermined cost-effectiveness. In probabilistic sensitivity analysis, the probability of SAVR being cost-effective was 97.93%, with 3-fold GDP per capita as the willingness-to-pay threshold.

CONCLUSIONS: From the Chinese healthcare perspective, in comparison with TAVR and individual therapy, SAVR would be considered highly cost-effective for patients with severe symptomatic AS including risk, age, and valve type subgroups. Contrary conclusions emerge for subgroup of low-risk patients.