Implante por cateter de bioprótese valvular aórtica para tratamento de estenose valvar aórtica grave em pacientes inoperáveis sob perspectiva da saúde suplementar: análise de custo-efetividade

Abstract

Background: Transcatheter aortic valve implantation (TAVI) is a new modality of treatment especially dedicated to patients with high surgical risk. In these patients, TAVI increased survival and improved quality of life when compared to standard treatment (drug therapy with or without percutaneous aortic balloon valvuloplasty). Our objective was to perform a costefficacy analysis of the implementation of TAVI in the Brazilian Supplemental Health System. Methods: We developed a predictive model to assess the cost-effectiveness of the procedure in the long-term, and a Weibull regression analysis with a time horizon of 5 and 10 years, to estimate survival data for over 24 months. In addition, a deterministic sequential Markov model was developed. Results were expressed as incremental cost-effectiveness ratio (ICER) per years of life saved and progression-free years of life. Results: In a standard scenario, where the cost of TAVI was estimated as R$ 65 millions, the ICER value (cost/year of life saved

Complicações em pacientes após substituição valvar aórtica percutânea

“…(11) In this study, our results matched several case studies published, in which we could notice a a similar profile. (2,3,11,14) The main pre-implant comorbidities presented by the patients were hypertension, dyslipidemia, high body mass index, non-dialysis chronic kidney disease, heart failure, diabetes mellitus, and current or former smokers. In previous studies, similar data were already found, highlighting the coronary artery disease, peripheral artery disease, prior cerebrovascular accident and prior coronary artery bypass grafting (CABG).…”

“…In all studies, the high percentage of systemic arterial hypertension and heart failure were extremely relevant. (3,9,11,14) In the PARTNER study, the profile found was as follows: women (57.8%), elderly people (83.6 ± 6.8) with comorbidities such as New York Heart Association (NYHA) class III or IV (94.3%), coronary artery disease (74.9%), chronic obstructive pulmonary disease (DPOC) (52.6%), peripheral vascular disease (43%), prior coronary artery bypass grafting surgery (42.6%), pulmonary hypertension (42.4%), atrial fibrillation (40.8%), previous angioplasty (34%), cerebrovascular accident (29.3%), previous acute myocardial infarction (26.8%), and definitive pacemaker (20%).…”

Implante percutâneo de bioprótese valvular aórtica: conciliando os valores clínicos e econômicos de um tratamento estabelecido

“…In the present issue of Revista Brasileira de Cardiologia Invasiva, Queiroga et al 20 evaluate, in a detailed study from the perspective of the private healthcare system, the ICER of TAVR in Brazil. Using estimates of the direct medical costs of the procedure (regarding hospital admission, the procedure itself, and administered medications) and the predictive statistical model based on the results of the PARTNER B trial, the authors performed an economic analysis of TAVR on the national scene.…”

“…The inclusion of the costs of aortic valvuloplasty in the group of patients kept under strict medical treatment could result in even lower values of ICER in the economic model adopted. Finally, it should be noted that the conclusions of the article of Queiroga et al 20 are based on the results of inoperable patients undergoing TAVR, and should not be extrapolated to patients with high surgical risk (assessed in the PARTNER A trial, with specific analysis of cost-effectiveness). 21 Ultimately, the challenge remains: how assure to the patients the high clinical value effectiveness of TAVR reconciling them to their high cost economic in Brazil?…”

Custo direto do implante por cateter de bioprótese valvar aórtica nas diferentes vias de acesso

“…Por ser de grande valia na tomada de decisões, facilita na escolha mais adequada, focando sempre a relação custo/efetividade dos procedimentos, considerando como resultado esperado a melhora da condição de saúde do paciente 49,67,119,121,129 . • Em razão da homogeneidade das características demográficas e clínicas dos pacientes, estas não foram consideradas fatores preditores para o aumento no custo médio do procedimento TAVI.…”