COST-EFFECTIVENESS OF SAPIEN 3 VS. EVOLUT PRO/PRO+ FOR TRANSCATHETER AORTIC VALVE REPLACEMENT: AN ECONOMIC EVALUATION IN ISRAEL
Author(s)
Francisco Ibañez Ortigosa, BS; MSc1, Carlos Crespo, BEc, BSc, MASc, MBA, MFE, MSc, DrPH, PhD2, JESUS CUERVO, MSc, PhD3, Mónica Cerezales, PhD4, Pascal Candolfi, PhD5.
1Consultant, Axentiva Solutions, BARCELONA, Spain, 2Axentiva Solutions, Barcelona, Spain, 3AXENTIVA SOLUTIONS, SL, Oviedo, Spain, 4Axentiva Solutions SL, Oviedo, Spain, 5Edwards Lifesciences Sàrl, Nyon, Switzerland.
1Consultant, Axentiva Solutions, BARCELONA, Spain, 2Axentiva Solutions, Barcelona, Spain, 3AXENTIVA SOLUTIONS, SL, Oviedo, Spain, 4Axentiva Solutions SL, Oviedo, Spain, 5Edwards Lifesciences Sàrl, Nyon, Switzerland.
OBJECTIVES: While Transcatheter aortic valve replacement (TAVR) is an established alternative to surgery in patients with symptomatic severe aortic stenosis (AS), comparing specific device value remains essential for efficient healthcare resource allocation. This study sought to evaluate the cost-effectiveness of the SAPIEN 3 (S3) versus Evolut Pro/Pro+ (EVO) from the Israeli Health Maintenance Organization (HMO) perspective.
METHODS: A cost-effectiveness analysis was conducted using a Markov model with a 5-year time horizon and 30-day cycles. Clinical inputs were derived from local real-world evidence (RWE), adjusted with international data for long-term outcomes. Total costs (in Israeli shekels [ILS]), quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) were calculated against a country-specific willingness-to-pay threshold of ILS550,889. Both deterministic and probabilistic sensitivity analyses (PSA) were performed to evaluate model uncertainty. A scenario analysis relying on inputs from recent meta-analyses and large international studies was also performed to check external validity.
RESULTS: In the base case, TAVR with S3 yielded additional 0.50 QALYs over 5 years compared to EVO, at an incremental cost of ILS11,759. The resulting ICER was ILS23,600 /QALY gained. The PSA confirmed that S3 was cost-effective in 99.5% of iterations. Additionally, the scenario analysis corroborated these findings, yielding an ICER of ILS27,040 /QALY gained.
CONCLUSIONS: Based on local RWE, S3 is a highly cost-effective alternative to EVO for TAVR in Israel. By leveraging local RWE alongside international evidence, this analysis provides critical insights to support clinical decision-making and ensure a more efficient healthcare resource allocation within the Israeli healthcare system.
METHODS: A cost-effectiveness analysis was conducted using a Markov model with a 5-year time horizon and 30-day cycles. Clinical inputs were derived from local real-world evidence (RWE), adjusted with international data for long-term outcomes. Total costs (in Israeli shekels [ILS]), quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) were calculated against a country-specific willingness-to-pay threshold of ILS550,889. Both deterministic and probabilistic sensitivity analyses (PSA) were performed to evaluate model uncertainty. A scenario analysis relying on inputs from recent meta-analyses and large international studies was also performed to check external validity.
RESULTS: In the base case, TAVR with S3 yielded additional 0.50 QALYs over 5 years compared to EVO, at an incremental cost of ILS11,759. The resulting ICER was ILS23,600 /QALY gained. The PSA confirmed that S3 was cost-effective in 99.5% of iterations. Additionally, the scenario analysis corroborated these findings, yielding an ICER of ILS27,040 /QALY gained.
CONCLUSIONS: Based on local RWE, S3 is a highly cost-effective alternative to EVO for TAVR in Israel. By leveraging local RWE alongside international evidence, this analysis provides critical insights to support clinical decision-making and ensure a more efficient healthcare resource allocation within the Israeli healthcare system.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE6
Topic
Economic Evaluation, Health Technology Assessment
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)