OBJECTIVES: Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive treatment option available for people with symptomatic severe aortic stenosis at risk for open chest Surgical Aortic Valve Replacement (SAVR). Patients undergoing TAVI have a reduced need for post-surgery rehabilitation compared with SAVR. Additionally, the SURTAVI trial has shown that TAVI determines a potential reduction in adverse events (AEs) such as stroke, atrial fibrillation and acute kidney injury in intermediate risk (IR) patients. This analysis aimed at assessing the potential budget impact of increasing the adoption rate of TAVI for IR in the Italian setting, based on the potential clinical benefit demonstrated in literature.

METHODS: A budget impact model was developed to quantify TAVI-related cost-savings accomplished through lower rehabilitation and lower AEs probability compared with SAVR. The model was developed from the Italian National Healthcare Service (NHS) perspective with a 2-year time horizon. Total IR national population eligible to TAVI was modeled. Costs included were index hospitalization, rehabilitation, outpatient follow-up, hospitalizations for adverse events. Average regional DRG tariffs were used to estimate costs for the payer. AEs risks were calculated based on the SURTAVI trial. At baseline, a 30% TAVI and a 70% SAVR adoption rate was assumed.

RESULTS: TAVI substantially reduces costs for the payer due to lower rehabilitation and decreased AEs. A 10% increase in adoption rate in TAVI would lead to a -1.094.292 € cost reduction for the Italian NHS. Decreasing rehabilitation days to 0 for TAVI would lead to an additional -1.072.015 € cost reduction.

CONCLUSIONS: Being a minimally invasive procedure, TAVI leads to payer savings after discharge related to lower rehabilitation, lower AEs and associated hospitalizations. Increasing the uptake of TAVI in IR patients would represent a convenient option for the Italian NHS, given its economic value that overcomes upfront financial barriers to innovative technologies.