OBJECTIVES

Various treatments are available for patients with aortic stenosis; the choice should account for patient individual characteristics but also cost and effectiveness. We performed a cost-effectiveness analysis (CEA) of minimally invasive sutureless aortic valve replacement (MIS-SU-AVR) vs conventional surgical AVR (cSAVR) and transcatheter aortic valve implantation (TAVI) and budget impact analysis (BIA) of MIS-SU-AVR reimbursement from public payer perspective in Poland.

METHODS

Separate CEA models were developed for cSAVR and TAVI comparisons. The former was based on the previously published link between cardiopulmonary bypass time and the risk of death and the expected survival. The parameters of other events (hospitalization length or pacemaker implantation) were based on a systematic review. In the latter comparison, we developed a partitioned survival model. The model was based on the survival data from published literature, extrapolated to 10 years (results were based on the restricted mean survival time).

In BIA, the number of patients was based on data on MIS-SU-AVR in other countries. The patients using MIS-SU-AVR in the new scenario recruit from cSAVR or TAVI; the proportion was based on current diagnosis-related groups statistics. The cost of the procedure was based on current cSAVR cost, adjusting for the device cost; other costs were based of the National Health Fund data.

RESULTS

In the CEA, MIS-SU-AVR offers clinical benefits vs cSAVR and TAVI (0.1 and 1.1 life years gained, respectively) and is cost saving vs TAVI (hence, dominant). The incremental cost effectiveness ratio vs cSAVR amounts to 32,544 EUR (below the official threshold).

In the BIA, there would be 102, 182, 429, and 560 MIS-SU-AVR patients in consecutive years. Introducing MIS-SU-AVR would result in net savings (‘000s EUR): 73, 131, 305, and 403, respectively.

CONCLUSIONS

MIS-SU-AVR is cost-effective vs cSAVR and TAVI and its reimbursement would result in net savings in Poland.