Cost-Effectiveness of Transcatheter Aortic Valve Implantation in Low Surgical Risk Symptomatic Severe Aortic Stenosis Patients in Brazil

OBJECTIVES: A growing evidence base supports the economic benefits of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement (SAVR) in symptomatic severe aortic stenosis (sSAS) patients at low surgical risk across several European countries. However, there is scarce data on the cost-effectiveness of TAVI for this specific population in Brazil. Hence, this study aims to assess the cost-effectiveness of TAVI over SAVR in Brazilian sSAS patients at low risk (LR) of surgical mortality using clinical outcomes from the recent PARTNER 3 pivotal trial and Brazilian direct healthcare costs and patient outcomes data.

METHODS: A previously published two-stage cost-utility model was adapted to the Brazilian context. An initial decision tree structure captured short-term outcomes including adverse events, extracted from the trial for both the TAVI and the SAVR arms. Next, a Markov model with four health states captured disease progression and longer-term outcomes for patients. Costs were measured in Brazilian Reais (BRL$) and benefits in QALYs gained. The analysis was carried out from the Brazilian private payer perspective (SSS), the simulated time horizon was lifetime and accrued costs and benefits were discounted at 5% annually. The effect of uncertainty in model assumptions and parameters were explored through multiple sensitivity and scenario analyses

RESULTS: In comparison to SAVR, TAVI resulted in improved outcomes and higher costs over a lifetime horizon. With a QALY gain of +0.77 and increased costs of BRL $ 91,912 per patient for TAVI compared with SAVR, the incremental cost effectiveness ratio (ICER) for the base case was BRL $119,549 /QALY. These results are robust, with uncertainty assessed through various further sensitivity analyses.

CONCLUSIONS: In this study, TAVI improves outcomes in Brazilian LR sSAS patients and increases costs. These results are informative for policy makers in the private sector in Brazil as TAVI might be a cost-effective treatment option.