Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Severe Aortic Stenosis

Zhou, Jennifer; Liew, Danny; Duffy, Stephen J.; Walton, Antony; Htun, N.

doi:10.1016/j.hlc.2020.09.934

Cited by 22 publications

(41 citation statements)

References 28 publications

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“…In addition to those identified in the systematic reviews, 8 relevant economic evaluations 22,24,[27][28][29][30][31][32] were identified. All 8 economic evaluations 22,24,[27][28][29][30][31][32] were conducted as cost-utility analyses and incorporated Markov models that included between 2 31 and 9 24,28,29 health states. The time horizons were 8 years, 32 15 years, 24,[27][28][29] and lifetime.…”

Section: Methodsmentioning

confidence: 99%

“…The time horizons were 8 years, 32 15 years, 24,[27][28][29] and lifetime. 22,30,31 The analysis by Himmels 31 used a decision tree model for the initial 2 years of analysis that fed into a Markov model with 1-year cycles with 2 states: alive and dead. The model was from the perspective of public health care payers and used a lifetime horizon.…”

Section: Methodsmentioning

confidence: 99%

“…These comprised 3 HTAs (each included a systematic review [22][23][24] ; 2 included primary economic evaluations 22,24 ), 2 systematic reviews, 25,26 and 6 economic evaluations. [27][28][29][30][31][32] Appendix 1 presents the PRISMA 33 flow chart of the study selection. Additional references of potential interest are provided in Appendix 6.…”

Section: Quantity Of Research Availablementioning

confidence: 99%

“…Three relevant HTAs (which included 3 systematic reviews [22][23][24] and 2 de novo economic evaluations 22,24 ), 2 systematic reviews, 25,26 and 6 economic evaluations [27][28][29][30][31][32] were included in this review. The components of the identified HTAs that are relevant to this report (i.e., 3 systematic reviews and 2 economic evaluations) will be described individually, as much of the other information contained in these HTAs is beyond the scope of the current report.…”

Section: Summary Of Study Characteristicsmentioning

confidence: 99%

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Transcatheter Aortic Valve Implantation for Patients with Severe Symptomatic Aortic Stenosis

Young¹,

Horton²

2021

cjht

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The cost-effectiveness of transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement was examined in patients with severe symptomatic aortic stenosis at high, intermediate, and low surgical risk, and the findings were mixed. When compared to surgical aortic valve replacement, some studies suggest that TAVI is cost-effective (less costly and/or more effective) and some studies suggest that TAVI is not cost-effective. Factors such as the type of TAVI system used, the cost of treatment-associated expenses (such as post-operative follow-up costs and hospitalization costs), and the characteristics of patients selected for treatment likely impact the cost-effectiveness of TAVI for patients with severe symptomatic aortic stenosis.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Quantity Of Research Availablementioning

confidence: 99%

Section: Summary Of Study Characteristicsmentioning

confidence: 99%

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Transcatheter Aortic Valve Implantation for Patients with Severe Symptomatic Aortic Stenosis

Young¹,

Horton²

2021

cjht

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“…5,6 The high cost of TAVR devices and increased costs compared to SAVR have prompted concerns of cost efficacy. [7][8][9][10][11][12][13] The use of monitored anesthesia care (MAC) has evolved as one potential strategy for cost savings. MAC has increasingly been employed as a safe and effective alternative to general anesthesia (GA), with the proportion of TAVR performed under MAC nearly doubling from 33% in 2016 to 64% in 2019.…”

Section: Introductionmentioning

confidence: 99%

Monitored Anesthesia Care versus General Anesthesia for Transcatheter Aortic Valve Replacement

Neal

et al. 2021

Preprint

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Background: Monitored Anesthesia Care (MAC) has been increasingly used in lieu of general anesthesia (GA) for transcatheter aortic valve replacement (TAVR). We sought to compare outcomes and in-hospital costs between MAC and GA for TAVR at a single center Veterans Affairs Medical Center. Methods: A single-center retrospective review of 349 patients who underwent TAVR (MAC, n = 244 vs. GA, n = 105) from January 2014 to December 2019 was performed. Baseline patient characteristics, operating room (OR) time, intensive care unit (ICU) length of stay (LOS) and cost, total LOS, hospital cost, total cost, and complication rates were collected. Propensity matching was performed and resulted in 83 matched pairs. Results: In the unmatched TAVR cohort, MAC TAVR was associated with reduced OR time (146 vs. 198 minutes, P < .0001), ICU LOS (1.4 vs. 1.8 days, P < 0.0001), total hospital LOS (3.4 vs. 5.4 days, P < .0001), and lower index total cost ($81,3000 vs. $85,400, P = .010). After propensity matching, MAC TAVR patients had reduced OR time (146 vs. 196 minutes, P < 0.05), ICU LOS (1.2 vs. 1.7 days, P = .006), total LOS (3.5 vs. 5.1 days, P = .001), and 180-day mortality (2.4% vs. 12%, P < 0.03). There was no difference in total hospitalization cost or total cost. Conclusions: In propensity matched groups, TAVR utilizing MAC is associated with improved OR time efficiency, decreased LOS, and a reduction in 180-day mortality, but no significant difference in cost.

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Incorporating economic analysis in interventional cardiology research

O’Byrne

Wilensky

Glatz

2022

Cathet Cardio Intervent

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Evaluative research in interventional cardiology has focused on clinical and technical outcomes. Inclusion of economic data can enhance evaluative research by quantifying the relative economic burden incurred by different therapies. When combined with clinical outcomes, cost data can provide a measure of value (e.g., marginal cost‐effectiveness). In some select situations, cost data can also be used as surrogates for complexity of care and morbidity. In this narrative review, we aim to provide a framework for the application of cost data in clinical trials and observational research, detailing how to incorporate this kind of data into interventional cardiology research.

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Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Severe Aortic Stenosis

Cited by 22 publications

References 28 publications

Transcatheter Aortic Valve Implantation for Patients with Severe Symptomatic Aortic Stenosis

Transcatheter Aortic Valve Implantation for Patients with Severe Symptomatic Aortic Stenosis

Monitored Anesthesia Care versus General Anesthesia for Transcatheter Aortic Valve Replacement

Incorporating economic analysis in interventional cardiology research

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