Transcatheter aortic valve implantation: first choice for aortic stenosis?

Heijer, Peter den

doi:10.1007/s12471-020-01419-9

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…PARTNER 3 data also showed that more patients after TAVI were discharged to ‘home or selfcare (routine discharge)’, while in the surgery group, more patients were discharged to a skilled nursing facility or an inpatient rehabilitation facility. Concerns about the invasiveness and recovery period regarding SAVR were expressed in a recent Dutch study emphasizing the impact of the disease on daily functioning [ 43 ]. Consistent with European clinical guidelines [ 14 ], it is common Dutch practice that the cardiologist and Heart Team makes decisions in consultation with the patient, increasing patient autonomy.…”

Section: Discussionmentioning

confidence: 99%

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

Eerdekens,

Kats,

Grutters

et al. 2024

Cost Eff Resour Alloc

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Background There is growing evidence to support the benefits of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis (sSAS) who are at high- or intermediate-risk of surgical mortality. The PARTNER 3 trial showed clinical benefits with SAPIEN 3 TAVI compared with SAVR in patients at low risk of surgical mortality. Whether TAVI is also cost-effective compared with SAVR for low-risk patients in the Dutch healthcare system remains uncertain. This article presents an analysis using PARTNER 3 outcomes and costs data from the Netherlands to inform a cost-utility model and examine cost implications of TAVI over SAVR in a Dutch low-risk population. Methods A two-stage cost-utility analysis was performed using a published and validated health economic model based on adverse events with both TAVI and SAVR interventions from a published randomized low risk trial dataset, and a Markov model that captured lifetime healthcare costs and patient outcomes post-intervention. The model was adapted using Netherlands-specific cost data to assess the cost-effectiveness of TAVI and SAVR. Uncertainty was addressed using deterministic and probabilistic sensitivity analyses. Results TAVI generated 0.89 additional quality-adjusted life years (QALYs) at a €4742 increase in costs per patient compared with SAVR over a lifetime time horizon, representing an incremental cost-effectiveness ratio (ICER) of €5346 per QALY gained. Sensitivity analyses confirm robust results, with TAVI remaining cost-effective across several sensitivity analyses. Conclusions Based on the model results, compared with SAVR, TAVI with SAPIEN 3 appears cost-effective for the treatment of Dutch patients with sSAS who are at low risk of surgical mortality. Qualitative data suggest broader societal benefits are likely and these findings could be used to optimize appropriate intervention selection for this patient population.

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Section: Discussionmentioning

confidence: 99%

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

Eerdekens,

Kats,

Grutters

et al. 2024

Cost Eff Resour Alloc

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“…The only countries with plateauing or declining mortality for both sexes (Germany and Netherlands) were early TAVI adopters, and have well-established TAVI practise and registries. Indeed, Germany performs the most TAVIs in Europe, whilst TAVI far exceeds SAVR in the Netherlands ( 17 , 18 ). Procedural complications and mortality reduce with greater TAVI experience ( 19 ), which may contribute, along with the greater TAVI numbers, to the declining AS mortality in these countries.…”

Section: Discussionmentioning

confidence: 99%

Trends in Mortality From Aortic Stenosis in Europe: 2000–2017

Hartley

Hammond‐Haley

Marshall

et al. 2021

Front. Cardiovasc. Med.

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Background: Trends in mortality from aortic stenosis across European countries are not well-understood, especially given the significant growth in transcatheter aortic valve implantation (TAVI) in the last 10 years.Methods: Age-standardised death rates were extracted from the World Health Organisation Mortality Database, using the International Classification of Diseases 10th edition code for non-rheumatic aortic stenosis for those aged > 45 years between 2000 and 2017. The UK and countries from the European Union with at least 1,000,000 inhabitants and at least 50% available datapoints over the study period were included: a total of 23 countries. Trends were described using Joinpoint regression analysis.Results: No reductions in mortality were demonstrated across all countries 2000–2017. Large increases in mortality were found for Croatia, Poland and Slovakia for both sexes (>300% change). Mortality plateaued in Germany from 2008 in females and 2012 in males, whilst mortality in the Netherlands declined for both sexes from 2007. Mortality differences between the sexes were observed, with greater mortality for males than females across most countries.Conclusions: Mortality from aortic stenosis has increased across Europe from 2000 to 2017. There are, however, sizable differences in mortality trends between Eastern and Western European countries. The need for health resource planning strategies to specifically target AS, particularly given the expected increase with ageing populations, is highlighted.

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