OBJECTIVES : Clinical evidence has shown unequivocally that transcatheter aortic valve replacement (TAVR) is a life saving treatment option in patients with inoperable Severe Aortic Stenosis (SAS). This study aimed to assess the cost-effectiveness of TAVR compared with standard medical therapy (SMT) in inoperable patients with SAS, from the Mexican Public Health System (MPHS) perspective.

METHODS : A novel 9 health state Markov model, constructed by IMS Health, was used to simulate the clinical course of inoperable patients with SAS treated with TAVR or SMT. Health states were based on heart failure severity defined by the New York Heart Association (NYHA) classification and the history of stroke. The analysis accounts direct costs (MPHS perspective) only over a 10 year time horizon. Clinical data on the patient’s progression over time were taken from the PARTNER 1B-trial. Costs were retrieved from literature and utilities derived from the study data. Annual discounting of 5.0% was applied. The outcome of the analysis was cost ($MXN) per quality adjusted life year (QALY) gained. The analysis included one way and probabilistic sensitivity analyses to investigate the impact of parameter variability on model outputs.

RESULTS : Compared with SMT, TAVR was associated with higher costs (MXN 527,472.66) and more QALYs (1.46), resulting in an incremental cost-effectiveness ratio of MXN 362,414. Sensitivity analyses indicated that the key drivers of the model were cost of TAVR, cost of balloon valvuloplasty and mortality.

CONCLUSIONS : In the Mexican setting, TAVR can be considered a cost-effective treatment option versus SMT in inoperable patients with SAS.