OBJECTIVES: A budget impact analysis (BIA) comparing transcatheter aortic valve replacement (TAVR) with SAPIEN 3 versus surgical aortic valve replacement (SAVR) for severe, symptomatic aortic stenosis (SSAS) among patients of low, intermediate, and high surgical risk.

METHODS: An international budget impact model was adapted with cost inputs sourced from published evidence predominantly on Medicare and Medicaid populations in the United States. The TAVR and SAVR-related complications were costed and included new permanent pacemaker implantation (PPI), atrial fibrillation (AF), major disabling stroke (MDS), and surgical site infections (SSI). Cost inputs were extracted, compared, and calculated for single and multisource estimates per outcome. One-way sensitivity analyses (OWSA) were performed on cost and probability inputs.

RESULTS: At 5 years, TAVR saves $20,566, $21,913, and $78,730 compared with SAVR in low, intermediate, and high-risk patients, respectively. TAVR is associated with higher PPI costs and budget savings for complications such as AF, MDS, and SSI. TAVR’s shorter hospital intensive care unit (ICU) and non-ICU stays result in budget savings that offset the device costs among intermediate and high-risk patients. The cost driver for low-risk surgical patients is SAVR per month cost of AF, TAVR device cost for intermediate risk, and TAVR cost of ICU per day for high-risk.

CONCLUSIONS: TAVR is projected to be economically beneficial by lowering inpatient and long-term complication costs compared with SAVR in the US. TAVR with SAPIEN 3 may be the preferred treatment strategy for SSAS patients from the perspective of Medicare and Medicaid.