COST-UTILITY OF TRANSCATHETER AORTIC VALVE IMPLANTATION COMPARED WITH SURGICAL AORTIC VALVE REPLACEMENT IN HIGH-RISK PATIENTS WITH SEVERE AORTIC STENOSIS- A PROSPECTIVE OBSERVATIONAL STUDY

Author(s)

Ribera A¹, Ferreira-González I¹, Slof J², Cascant P¹, Abdul-Jawad O¹, Marsal JR¹, Serra V¹, Garcia del Blanco B¹, Tornos P¹, Sureda C¹, Falces C³, Andrea R³, Gutiérrez E⁴, del Valle R⁵, Mota P⁶, Goicolea J⁷, Permanyer G¹, Garcia-Dorado D¹
¹Vall d'Hebron University Hospital, Barcelona, Spain, ²Universitat Autonoma de Barcelona, Bellaterra, Spain, ³Hospital Clínic i Provincial de Barcelona, Barcelona, Spain, ⁴Instituto de Investigación Sanitaria Gregorio Maranon, Universidad Complutense, Madrid, Spain, ⁵Hospital Central de Asturias, Oviedo, Spain, ⁶Hospital Clínico de Valladolid, Valladolid, Spain, ⁷Hospital Puerta de Hierro/Majadahonda, Madrid, Spain

Presentation Documents

MD2--strong-u-ribera-a-u-sup-1-sup-strong-ferreira-gonzalez-i-sup-1-sup-slof-j-sup-2-sup-cascant-p-sup-1-sup-abdul-jawad-o-sup-1-sup-marsal-jr-sup-1-sup-serra-v-sup-1-sup-garcia-del-blanco-b-sup-1-sup-tornos-p-sup-1-sup-sureda-c-sup-1-sup-f ...

OBJECTIVES: : Transcatheter aortic valve implantation (TAVI) is a treatment option for patients with severe symptomatic aortic stenosis ineligible for surgical treatment (AVR). However, the role of TAVI in patients who are potential surgical candidates remains controversial and its cost-effectiveness has only been assessed using data from one single randomized trial. We sought to estimate the cost-utility of the two existing transfemoral TAVI modalities (Edwards SAPIEN (ES) and Medtronic Corevalve (MC)) versus conventional surgery using data from “real-life” patients. METHODS: : Prospective recruitment in 7 Spanish hospitals, with follow-up at one, three and six months after intervention. We measured utility with EQ5D. We estimated crude and adjusted differences in costs and QALYs using regression analyses with bootstrap estimation of variance. We calculated incremental cost-utility ratios (ICER) comparing ES and MC to AVR and derived cost-effectiveness acceptability curves. Subgroup and sensitivity analyses were performed. RESULTS: : Data from 48 ES-TAVI, 86 MC-TAVI and 52 AVR patients were analyzed; 4 were lost to follow up. Mean STS risk score was: ES: 4.9 (3), MC: 5.1 (3), AVR: 5.1 (2). Overall cost of ES-TAVI was 7,202 € higher than AVR (adjusted difference: 5,474; 95%CI: 926-11,875) and the difference in QALYs was 0.045 (adjusted difference: 0.041; 95%CI: -0.015 – 0.96), resulting in an ICER of 161,086 €/QALY. The cost of MC-TAVI was 7,476 € higher than AVR (adjusted difference: 8,738; 95%CI: 4,480 – 12,997) and the difference in QALYs was 0.003 (adjusted difference: 0.025; 95%CI: -0.027 – 0.77), resulting in an ICER of 2,451,568 €/QALY. The results were mainly driven by the high cost of the TAVI device and did not substantially change in the sensitivity analysis and subgroups. CONCLUSIONS: : In the Spanish setting, the use of transfemoral TAVI when surgery is feasible is not likely to be cost-effective at a willingness-to-pay threshold of 30,000 €/QALY.

Conference/Value in Health Info

2014-05, ISPOR 2014, Palais des Congres de Montreal

Value in Health, Vol. 17, No. 3 (May 2014)

Code

MD2

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Cardiovascular Disorders

Explore Related HEOR by Topic

Economic Evaluation

Presentation