Cost-utility analysis of TAVI compared with surgery in patients with severe aortic stenosis at low risk of surgical mortality in the Netherlands

Background: Transcatheter Aortic Valve Implantation (TAVI) has emerged as a standard of care for patients suffering from symptomatic severe aortic stenosis. However, organisational analyses and investigations of this intervention’s economic impact are lacking. This study aims to assess the potential impact of implementing a process designed to optimise the TAVI pathway regarding organisational, human, material, and economic resources. Methods: The research is conducted through a case study. The methodology consisted of three stages: 1. mapping of the current TAVI pathway; 2. identification of the organisational changes necessary to optimise it and implementation of the identified action with a multidisciplinary teamwork; 3. simulations of the organisational and economic impact of the optimisation process. Data related to costs, revenues, and activities were provided by the hospital’s Management Control office. The data analysed refer to a 12-month period. The TAVI pathway optimization presented in this analysis is aligned with the best practices described in the BENCHMARK study. Results: The analysis of the current TAVI pathway in the studied hospital highlighted several critical points during the three phases of the course (pre-procedure, peri-procedure, and post-procedure). The working groups identified five areas for TAVI pathway improvement: patient and family education, coronary risk stratification, conduction disorders management, fast-track discharge eligibility, nurse-led rapid mobilisation and early discharge. The organisational solutions highlighted by the working groups outline a new TAVI pathway capable of generating a significant impact not only from an organisational point of view, but also from an economic point of view. We estimated that in our cohort TAVI optimisation would have saved approximately 112 ICCU bed-days and have led to an average cost reduction of about €3,900 per patient. Conclusions: This study showed a process of optimisation of the TAVI pathway highlighting the positive impacts for patients, caregivers, healthcare workers, and the hospital. A Clinical Valve Coordinator may help to manage the procedural programme for individual patients while maintaining seamless communication with the Heart Team throughout the patient care journey, making the process even more streamlined. The case study analysed can be useful to all hospitals wishing to undertake processes aimed at improving the TAVI pathway.

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Transcatheter aortic valve implantation with SAPIEN 3 versus surgical aortic valve replacement in patients with symptomatic severe aortic stenosis at low risk of surgical mortality: a cost-utility analysis for Switzerland

Wyss,

Corti,

Nestelberger

et al. 2024

Swiss Med Wkly

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AIMS OF THE STUDY: The 2021 European Society of Cardiology Guidelines on valvular heart disease recommend transcatheter aortic valve implantation (TAVI) for patients with symptomatic severe aortic stenosis at low surgical risk and age ≥75 years who are suitable for a transfemoral approach (recommendation class IA) based on two large randomised controlled trials (PARTNER 3 and Evolut Low Risk) comparing transcatheter aortic valve implantation with surgical aortic valve replacement (SAVR). Whether such an approach is cost-effective in Switzerland remains unclear. The aim of this cost-utility analysis was to compare transcatheter aortic valve implantation with SAPIEN 3 versus surgical aortic valve replacement in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of Swiss compulsory health insurance using data from the PARTNER 3 trial (reflecting specifically the safety and efficacy of the SAPIEN 3 TAVI device). METHODS: A previously published two-stage Markov-based model that captured clinical outcomes from the PARTNER 3 trial was adapted from the perspective of the Swiss compulsory health insurance system, using local or geographically close general population mortality and utility data, unit costs and medical resource use from publicly available sources and based on expert opinion. The model had a lifetime horizon with a 3% yearly discounting factor. The cost–utility analysis estimated changes in both direct healthcare costs and health-related quality-adjusted life years for transcatheter aortic valve implantation compared with surgical aortic valve replacement in patients with symptomatic severe aortic stenosis at low risk of surgical mortality. RESULTS: Overall, transcatheter aortic valve implantation with SAPIEN 3 resulted in lifetime costs per patient of CHF 79,534 and quality-adjusted life years per patient of 9.64, compared with surgical aortic valve replacement lifetime costs and quality-adjusted life years per patient of CHF 76,891 and 8.96, respectively. Compared with surgical aortic valve replacement, transcatheter aortic valve implantation was estimated to offer an incremental improvement of +0.68 quality-adjusted life years per patient at an increased cost of +CHF 2643 per patient over a lifetime horizon. The incremental cost-effectiveness ratio was CHF 3866 per quality-adjusted life year gained and remained below CHF 50,000 per quality-adjusted life year gained across several sensitivity analyses. CONCLUSIONS: This analysis suggests that transcatheter aortic valve implantation using the SAPIEN 3 device is likely to be a highly cost-effective alternative for symptomatic severe aortic stenosis patients at a low risk of surgical mortality, treated in the contemporary Swiss setting. These findings may help to inform a holistic approach when making policy decisions for the management of this patient group.

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Cost-utility analysis of TAVI compared with surgery in patients with severe aortic stenosis at low risk of surgical mortality in the Netherlands

Cited by 3 publications

References 35 publications

Cost-effectiveness analysis of transcatheter aortic valve implantation in aortic stenosis patients at low- and intermediate-surgical risk in Japan

Cost-effectiveness analysis of transcatheter aortic valve implantation in aortic stenosis patients at low- and intermediate-surgical risk in Japan

Economic impact of TAVI pathway optimisation: the experience of the University Hospital of Parma.

Transcatheter aortic valve implantation with SAPIEN 3 versus surgical aortic valve replacement in patients with symptomatic severe aortic stenosis at low risk of surgical mortality: a cost-utility analysis for Switzerland

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