Systematic review of model-based economic evaluations of heart valve implantations

Huygens, Simone; Takkenberg, Johanna J.M.; Mölken, Maureen P.M.H. Rutten-van

doi:10.1007/s10198-017-0880-z

Cited by 14 publications

(9 citation statements)

References 51 publications

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“…A recent systematic review of 14 decision-analytic models regarding the cost-effectiveness analyses of heart valve implantations describes the gist of this presentation: in most studies, TAVI was cost-effective compared to standard treatment in inoperable or high-risk operable patients, albeit with a high variation of the ICER range (€18,421-€120,779) ($21,000-$136,480) (40). In all studies, surgical AVR was cost-effective compared to standard therapy in operable patients [ICER range €14,108-€40,944 ($16,000-$46,000)], but the results were not consistent on the costeffectiveness of TAVI vs. AVR in high-risk operable patients (ICER range: dominant to dominated by AVR).…”

Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve implantation economics: a grisly reality

Manolis¹

2017

Ann. Cardiothorac. Surg.

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Transcatheter aortic valve implantation (TAVI), an established treatment for inoperable and highrisk operable symptomatic patients with severe aortic stenosis with growing numbers of procedures and expanding indications, is an expensive therapy. Cost-effectiveness analyses rely on the value of the incremental cost-effectiveness ratio (ICER), which is the difference in cost between two possible interventions, divided by the difference in their effect. Several analyses have demonstrated that TAVI is costeffective with an acceptable ICER for the inoperable patient alone and only via the iliofemoral route, while TAVI is more costly and is either less or equally effective as surgery in high-risk operable patients. When use of TAVI is extended to include a larger number of patients suitable for surgery, the overall results become less favorable. Acceptable ICERs should practically equate to the value of the gross domestic product (GDP) per capita in each country; however, the cost of the TAVI kit alone already exceeds the GDP per capita of all moderate-and low-income countries. An overview of the current cost-efficacy issues of TAVI is presented and this grisly reality is discussed, which may hopefully be improved in the future.

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Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve implantation economics: a grisly reality

Manolis¹

2017

Ann. Cardiothorac. Surg.

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“…ICER). 30,31 In contrast, the cost-effectiveness of TAVI compared to surgical aortic valve replacement (SAVR) in highrisk operable patients is less straightforward. The price of the TAVI device is substantially higher than the price of surgical valve prostheses (≈$30,000 or ≈€18,000 for TAVI devices versus ≈$5000 or ≈€3000 for surgical valve prostheses 29,32 ).…”

Section: Case 3: the Societal Perspective: Balancing Risks Benefits And Costs Of Treatment Optionsmentioning

confidence: 99%

“…[32][33][34] Despite these cost reductions, TAVI remains more expensive than SAVR. [31][32][33][34] The higher costs of TAVI compared to SAVR need to be compensated with benefits in health outcomes in order for TAVI to be cost-effective. Most cost-effectiveness studies have shown small differences in QALYs (ranging from −0.61 35 to 0.32 34 QALYs) after TAVI compared to SAVR, but the majority is in favor of TAVI.…”

Section: Case 3: the Societal Perspective: Balancing Risks Benefits And Costs Of Treatment Optionsmentioning

confidence: 99%

“…Most cost-effectiveness studies have shown small differences in QALYs (ranging from −0.61 35 to 0.32 34 QALYs) after TAVI compared to SAVR, but the majority is in favor of TAVI. 31,33,34 These differences in estimated costs and health outcomes between studies have resulted in inconsistent costeffectiveness estimates. 31,33,34 The large US trials and several model-based economic evaluations in other countries reported acceptable cost-effectiveness estimates, 31,33,34 while other studies report less favorable cost-effectiveness estimates of TAVI compared to SAVR.…”

Section: Case 3: the Societal Perspective: Balancing Risks Benefits And Costs Of Treatment Optionsmentioning

confidence: 99%

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The Risk in Avoiding Risk: Optimizing Decision Making in Structural Heart Disease Interventions

2018

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Due to public audit of operative mortality after cardiac surgery, surgeons tend to avoid procedures with high early mortality risk. However there may be considerable risks in avoiding this risk. Careful balancing of therapeutic options from both the clinical perspective, the patient perspective, and from societal perspective, including taking the long view on outcome, is essential for optimal tailoring of treatment to the individual patient in current clinical practice. Illustrated by three structural heart disease cases, all three perspectives are discussed in this paper. From a clinical perspective, the risk in avoiding risk may be minimized by developing and using novel prognostic models that are able to simultaneously combine several longitudinally collected data during patient follow-up with these patients' outcome. From a patient perspective, the implementation of patient information portals and decision aids, to support shared decision making, will empower and serve the individual patient in balancing risks and benefits. From a societal perspective, there might be a risk in avoiding risk by reimbursing interventions with a small decrease in risk associated with high costs, causing limited access to other healthcare interventions with higher health gains using the same amount of resources. Policy makers should therefore inform their funding decisions based on cost-effectiveness analyses. The tools described in this paperreliable prognostic models for clinicians, decision aids for patients, and cost-effectiveness models for health care decision makers-will help to find an optimal balance in 21st century structural heart disease treatment decision making from all perspectives.

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“…Transcatheter aortic valve implantation (TAVI) has experienced a remarkable uptake in patients with severe aortic stenosis and high surgical risk, with over 54,000 procedures between 2012 and 2015 in the USA alone 1 . Its cost-effectiveness in these populations has been established in various settings and for both balloonexpandable and self-expanding TAVI devices 2 .…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of transcatheter versus surgical aortic valve replacement in patients at lower surgical risk: results from the NOTION trial

Geisler¹,

Jørgensen²,

Thyregod³

et al. 2019

EuroIntervention

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Aims:The aim of this study was to estimate the cost-effectiveness of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in patients at lower surgical risk.Methods and results: Discounted costs from a societal perspective and effectiveness as quality-adjusted life years (QALYs) were projected to lifetime via a decision-analytic model calibrated to 60-month data from the NOTION trial. The base case assumed a scenario in which any mortality benefit would gradually fade out over time, with other scenarios explored in sensitivity analyses. The incremental cost-effectiveness ratio (ICER) was compared to the country-specific willingness-to-pay (WTP) threshold of 1.13 million Danish kroner (DKK). The base case ICER was DKK 696,264/QALY (around €72,100/QALY via purchasing parity adjustment). Variation in long-term mortality beyond five years led to limited variation of incremental costs (DKK 64,200 to 64,600), but a more pronounced variation in incremental QALYs (0.07 to 0.19 QALYs for most conservative and optimistic assumptions, compared to base case of 0.09 QALYs). All resulting ICERs (range DKK 334,200 to DKK 904,100 per QALY gained) were below the WTP threshold.Conclusions: TAVI in a cohort of primarily low surgical risk patients was found to be a cost-effective treatment strategy in the Danish healthcare system. Cost-effectiveness analyses in other settings are warranted as are registries given the sensitivity of the model to long-term mortality.

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Systematic review of model-based economic evaluations of heart valve implantations

Cited by 14 publications

References 51 publications

Transcatheter aortic valve implantation economics: a grisly reality

Transcatheter aortic valve implantation economics: a grisly reality

The Risk in Avoiding Risk: Optimizing Decision Making in Structural Heart Disease Interventions

Cost-effectiveness of transcatheter versus surgical aortic valve replacement in patients at lower surgical risk: results from the NOTION trial

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