OBJECTIVES: TAVI is a disruptive technology that is often recommended as the standard of care for patients with symptomatic severe aortic stenosis (sSAS). Whilst there have been many published economic evaluations of TAVI across all surgical groups, there is little evidence on the relative importance of different factors that influence cost-effectiveness. This study sought to identify these factors and quantify their role.

METHODS: A systematic literature review was conducted in Medline, Embase, Econlit, NHS EED, and the Tufts CEA registry to identify published economic evaluations of TAVI. This was supplemented by health technology assessment reports. Evidence on key characteristics was extracted and analysed using statistical methods (penalised logistic regression). The primary outcome was TAVI’s cost-effectiveness. Secondary outcomes were TAVI being dominant and the incremental health gains of TAVI.

RESULTS: Forty-two studies, reporting 65 unique analyses, were identified. Relative to its comparators, TAVI was found to be cost-effective and dominant in 74% and 20% of analyses, respectively. The largest driver of cost-effectiveness results was device generation, with the latest generation valves the most likely to be cost-effective. TAVI is most likely to be cost-effective in low-risk populations, and when performed via transfemoral access route. Cost-effectiveness was also found to be influenced by the modelling approach taken. Studies that found TAVI to be dominant always compared it to surgery and typically considered the latest generation valves. Largest health benefits were observed for the inoperable surgical risk group.

CONCLUSIONS: For patients with sSAS, TAVI seems to be a cost-effective treatment option. There are important differences by device generation, risk group and access route. It is crucial to consider these differences when appraising the health economic evidence-base for TAVI.