Análisis coste-efectividad del implante percutáneo de válvula aórtica SAPIEN 3 en pacientes con estenosis aórtica grave sintomática

Incorporating economic analysis in interventional cardiology research

“…Historically, the willingness to pay threshold in the United States has been $50,000 per QALY (based on the historical benefit of dialysis in adults with chronic renal insufficiency), though that has been questioned recently 55 . Willingness to pay varies broadly between countries (as do local costs for good and services), which has fueled parallel analyses of cost‐effectiveness in different countries 6,7,9,10,56–67 …”

“…These analyses are important because they can allow for identification of which aspects of each strategy drive differences in cost‐effectiveness and how much change would have to occur for the strategy to reflect good value. This type of analysis is also critically important to determine whether the results of one strategy are transmissible to other contexts where either outcomes or willingness to pay may differ significantly 6,7,9,10,56–67 …”

“…55 Willingness to pay varies broadly between countries (as do local costs for good and services), which has fueled parallel analyses of cost-effectiveness in different countries. 6,7,9,10,[56][57][58][59][60][61][62][63][64][65][66][67] This type of comparative effectiveness research is dependent on accurate subject-level estimation of QALY. Well-planned clinical trials can accurately measure QALY in adult subjects.…”

“…This type of analysis is also critically important to determine whether the results of one strategy are transmissible to other contexts where either outcomes or willingness to pay may differ significantly. 6,7,9,10,[56][57][58][59][60][61][62][63][64][65][66][67] When utility data are not available and significant differences in hard clinical outcomes are available, reporting the cost increase per life saved or other clinical outcome is an alternative. Further, in settings where clinical outcomes are demonstrated to be similar if not identical, one can argue that the lower cost method represents better value and is preferable.…”