OBJECTIVES: The comparative effectiveness of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in real-world settings for patients with aortic stenosis (AS) in Taiwan remains uncertain. This study aimed to assess the clinical and economic outcomes during and after the index admission for aortic valve replacement (AVR) in Taiwan.

METHODS: Using data from Taiwan’s National Health Insurance Research Database, AS patients who underwent TAVR or SAVR between January 2016 and December 2018 were identified. A 1:1 propensity score (PS) matched cohort was constructed and followed up for two years from the index admission for AVR. Clinical outcomes were compared using restricted mean survival time (RMST) analysis, and economic implications were assessed through incremental cost-effectiveness ratio (ICER) calculations.

RESULTS: A total of 455 patients underwent TAVR, while 832 patients received SAVR between 2016 and 2018. Among the 235 PS-matched pairs, patients who underwent TAVR experienced shorter median hospitalization periods, including total length of stay (15 vs. 20 days) and ICU stay (2 vs. 5 days), compared to patients who received SAVR. Furthermore, patients with TAVR demonstrated lower all-cause mortality rates, with a 2-year RMST difference of 0.087 years. However, patients receiving TAVR exhibited higher healthcare resource utilization both during and after the index admission. Overall, the ICER at 2 years was estimated to be NT$ 4,366,908 per life-year (three times Taiwan’s gross domestic product per capita: NT$ 2,533,455 in 2020). Subgroup analysis suggested that TAVR was more cost-effective for patients with a logistic EuroSCORE of ≥10 (ICER: NT$ 1,994,038 per life-year), while SAVR emerged as the dominant option for patients with a logistic EuroSCORE of <10.

CONCLUSIONS: TAVR demonstrated favorable clinical outcomes with shorter hospitalization periods and reduced all-cause mortality. However, considering its cost-effectiveness, TAVR appeared to be a viable option primarily for patients with a higher cardiac operative risk.