OBJECTIVES : The National Agency of Health is the regulatory agency in Brazil that determines which procedure-related costs health insurance must cover. Transcatheter aortic valve replacement (TAVR), a treatment for aortic valve stenosis (AVS), is not covered by medical insurance. The aim of this study was to evaluate the cost-effectiveness of TAVR for AVS treatment as a therapeutic alternative to surgical aortic valve replacement (SAVR) in private health insurance-Brazil.

METHODS : Cost-effectiveness analysis (CEA) was developed using the tree decision model in 70- to 85-year-old patients who were treated for severe AVS between 2015 and 2018 at Unimed Campinas Health Insurance. The outcomes for the CEA were death during hospital stay and hospitalization (≤8 and ≥9 days). The selected patients were stratified into 3 groups according to procedure and age: G1 (n= 39), 70 to 75 years, G2 (n=38), 76 to 80 years; and G3 (n=17), 81 to 85 years.

RESULTS : Ninety-one patients were selected for the CEA (TAVR: 30 and SAVR: 61). TAVR was not cost-effective regarding death in G1 and G2; however, in G3, treating CEA with TAVR would save US$ 448.00 (SAVR US$ 27,360.00 and TAVR US$ 27,808.00). Similarly, TAVR did not provide any benefits in terms of hospitalization (≤8 and ≥9 days) in G1 and G2, whereas in G3 treating CEA with TAVR would save US$ 10,144.00 (SAVR US$ 45,549.00 and TAVR US$ 55,693.00).

CONCLUSIONS : In our analyses, SAVR was more cost-effective for patients aged 70 to 80, whereas TAVR was favorable only in patients over 81 years of age. The main impact is the cost of the device (mean cost of TAVR is US$ 15,400.00). This decision was pioneered by Unimed Campinas Health Insurance’s use of TAVR even without ANS coverage in patients aged 81-85 years; the amount of cost savings could be up to 1 million USD in five years.