Cost-Effectiveness of TEVAR With Active Control in Patients With TAA and TBAD: A Japanese Public Healthcare Payer Perspective
Author(s)
Yoko Matsuo, MS1, Keita Mori, BA1, Daiki Matsushima, MS1, Tatsunori Murata, PhD2, Fujio Matsuyama, MS2, Shota Saito, PhD2, Tomoya Kudo, BS2, Naoki Tashiro, BS2.
1W. L. Gore & Associates G.K., Tokyo, Japan, 2CRECON Medical Assessment Inc., Tokyo, Japan.
1W. L. Gore & Associates G.K., Tokyo, Japan, 2CRECON Medical Assessment Inc., Tokyo, Japan.
OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) devices have undergone continuous technological advancements. Recently, devices equipped with an active control (AC) mechanism—featuring a multi-stage deployment system that enables precise proximal positioning and minimizes the influence of blood flow during deployment—have been introduced. The clinical benefits of this technological innovation have been recognized by the Japanese Ministry of Health, Labor and Welfare, resulting in the assignment of a premium reimbursement price in 2023. This study aimed to evaluate the cost-effectiveness of TEVAR devices with active control (TEVAR-AC) compared to conventional TEVAR devices without active control (TEVAR-noAC), from the perspective of the Japanese public healthcare payer, in patients with thoracic aortic aneurysm (TAA) and Stanford type B aortic dissection (TBAD).
METHODS: An indirect comparison of TEVAR-AC and TEVAR-noAC was conducted using clinical outcomes derived from registry data and published literature. A lifetime Markov model with 1-year cycles was developed to assess cost-effectiveness from the perspective of the Japanese public healthcare payer. The analysis incorporated costs related to devices, procedures, follow-up, and reinterventions. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay threshold set at JPY 5 million per quality-adjusted life year (QALY) gained.
RESULTS: In patients with TAA, TEVAR-AC increased QALYs by 0.003 and reduced total costs by JPY 736,030. In those with TBAD, TEVAR-AC yielded a QALY gain of 0.013 and a cost reduction of JPY 664,428. In both cohorts, TEVAR-AC was the dominant strategy, providing better health outcomes at lower costs. The main factors contributing to these results were the lower incidence of reintervention and the small number of stent grafts used during the initial procedure.
CONCLUSIONS: TEVAR-AC demonstrated to be dominant over TEVAR-noAC in the treatment of patients with TAA and TBAD, indicating a highly cost-effective therapeutic option that may contribute to healthcare cost savings.
METHODS: An indirect comparison of TEVAR-AC and TEVAR-noAC was conducted using clinical outcomes derived from registry data and published literature. A lifetime Markov model with 1-year cycles was developed to assess cost-effectiveness from the perspective of the Japanese public healthcare payer. The analysis incorporated costs related to devices, procedures, follow-up, and reinterventions. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay threshold set at JPY 5 million per quality-adjusted life year (QALY) gained.
RESULTS: In patients with TAA, TEVAR-AC increased QALYs by 0.003 and reduced total costs by JPY 736,030. In those with TBAD, TEVAR-AC yielded a QALY gain of 0.013 and a cost reduction of JPY 664,428. In both cohorts, TEVAR-AC was the dominant strategy, providing better health outcomes at lower costs. The main factors contributing to these results were the lower incidence of reintervention and the small number of stent grafts used during the initial procedure.
CONCLUSIONS: TEVAR-AC demonstrated to be dominant over TEVAR-noAC in the treatment of patients with TAA and TBAD, indicating a highly cost-effective therapeutic option that may contribute to healthcare cost savings.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE280
Topic
Economic Evaluation
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas