Cost-effectiveness of transcatheter aortic valve implantation (TAVI) for aortic stenosis in patients who are high risk or contraindicated for surgery: a model-based economic evaluation.
Rosanna Orlando,Mary Pennant,S Rooney,S Khogali,Susan Bayliss,A Hassan,David Moore,Pelham Barton +7 more
Reads0
Chats0
TLDR
The overall results suggest that, if a very substantial majority of TAVI patients are those unsuitable for SAVR, the cost-effectiveness of a broad policy of introducing T AVI may fall below £20,000 per QALY.Abstract:
Background Calcific aortic stenosis (AS) is a common valvular heart disease. Patients with severe symptomatic AS typically survive less than 3 years. In such patients, intervention with surgical aortic valve replacement (SAVR) may increase survival. However, in some patients SAVR is associated with a high operative risk and medical management is considered appropriate. Transcatheter aortic valve implantation (TAVI) is a relatively recent technique to avoid the invasiveness of open surgery. This procedure has been used for the treatment of patients with severe AS who are unsuitable for SAVR (because it is too high risk and/or for other reasons such as suffering from porcelain aorta) and is increasingly being considered for other patients. Objectives To determine the cost-effectiveness of TAVI being made available for patients who are high risk or contraindicated for SAVR through a review of existing economic evaluations and development of a model. Data sources and review methods Bibliographic databases [MEDLINE, EMBASE, The Cochrane Library, Health Technology Assessment (HTA), Database of Abstracts of Reviews of Effects (DARE) and NHS Economic Evaluation Database (EED), Centre for Reviews and Dissemination HTA, DARE and NHS EED], guideline resources, current trials registers, websites/grey literature and manufacturers' websites, and consultation with clinical experts were used to identify studies for the review and information for the model. Databases were searched from 2007 to November 2010. A model was built to assess the cost-effectiveness of TAVI separately in patients suitable and unsuitable for SAVR, together with overall results for the effect of making TAVI available. Substantial deterministic sensitivity analysis was carried out together with probabilistic sensitivity analysis. Results No fully published cost-effectiveness studies were found. Modelling patients not suitable for SAVR, the base-case results show TAVI as more costly but more effective than medical management, with an incremental cost-effectiveness ratio (ICER) of £12,900 per quality-adjusted life-year (QALY). The ICER was below £20,000 per QALY for over 99% of model runs in the probabilistic sensitivity analysis. For patients suitable for SAVR, the comparator with TAVI is a mixture of SAVR and medical management. TAVI is both more costly and less effective than this comparator assuming that most patients would receive SAVR in the absence of TAVI. This is robust to a number of assumption changes about the effects of treatment, but sensitive to assumptions about the proportion of patients receiving SAVR in the comparator. If the use of TAVI is extended to include more patients suitable for SAVR, the overall results from the model become less favourable for TAVI. Limitations The modelling involves extrapolation of short-term data and the comparison between TAVI and SAVR is not based on randomised data. More trial data on the latter have been published since the modelling was undertaken. Conclusions The results for TAVI compared with medical management in patients unsuitable for surgery are reasonably robust and suggest that TAVI is likely to be cost-effective. For patients suitable for SAVR, TAVI could be both more costly and less effective than SAVR. The overall results suggest that, if a very substantial majority of TAVI patients are those unsuitable for SAVR, the cost-effectiveness of a broad policy of introducing TAVI may fall below £20,000 per QALY. Future work required includes the incorporation of new data made available after completion of this work. Funding The National Institute for Health Research Health Technology Assessment programme.read more
Citations
More filters
Journal Article
Progress and Current Status of Percutaneous Aortic Valve Replacement: Results of Three Device Generations of the CoreValve Revalving System
EberhardGrube,LutzBuellesfeld,RalfMueller,BarthelSauren,BernfriedZickmann,DineshNair,HaraldBeucher,ThomasFelderhoff,SteinIversen,UlrichGerckens +9 more
TL;DR: A summary of the development and current safety and efficacy status of the self-expanding CoreValve Revalving prosthesis and procedural outcome, complications and clinical status up to 1 year is provided.
Journal ArticleDOI
Improving the Methods for the Economic Evaluation of Medical Devices.
TL;DR: By their very nature, most of the distinctive features of MDs cannot be fully assessed at market entry, however, their potential impact could be modelled, based on the experience with previous MDs, in order to make a preliminary recommendation.
Journal ArticleDOI
Cost-utility of transcatheter aortic valve implantation for inoperable patients with severe aortic stenosis treated by medical management: a UK cost-utility analysis based on patient-level data from the ADVANCE study
Stephen Brecker,Stuart Mealing,Amie Padhiar,James Eaton,Mark Sculpher,Rachele Busca,Johan Bosmans,Ulrich Gerckens,Peter Wenaweser,Corrado Tamburino,Sabine Bleiziffer,Nicolo Piazza,Neil Moat,Axel Linke +13 more
TL;DR: TAVI is highly likely to be a cost-effective treatment for patients with severe aortic stenosis from the perspective of the UK NHS, and the impact of uncertainty in key clinical areas is explored.
Journal ArticleDOI
Clinical significance of conduction disturbances after aortic valve intervention: current evidence
TL;DR: This review aims to evaluate the procedure- and patient-related factors that may contribute to the development of aberrant atrioventricular conduction following TAVI as well as its clinical consequences.
Journal ArticleDOI
Pathophysiology, incidence and predictors of conduction disturbances during Transcatheter Aortic Valve Implantation.
TL;DR: The evaluation of patient’s valve anatomy and the selection of the most appropriate prosthesis have been proposed as a valuable options to reduce the incidence of conductions disturbances and further characterization of the procedural- and patient-related factors that contribute to the development of conduction abnormalities will help to improve prosthesis designs and patient selection, making TAVI even more safer.
References
More filters
Journal ArticleDOI
Methods for the economic evaluation of health care programmes
TL;DR: Using archival material supplemented by interviews with community physicians, Jane Lewis shows how 'public health' and 'preventive medicine' have been supplanted as the central concern of medicine by curative and acute specialties.
Journal ArticleDOI
Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery
Martin B. Leon,Craig R. Smith,Michael J. Mack,D. Craig Miller,Jeffrey W. Moses,Lars G. Svensson,E. Murat Tuzcu,John G. Webb,Gregory P. Fontana,Raj Makkar,David L. Brown,Peter C. Block,Robert A. Guyton,Augusto D. Pichard,Joseph E. Bavaria,Howard C. Herrmann,Pamela S. Douglas,John L. Petersen,Jodi J. Akin,William N. Anderson,Duolao Wang,Stuart J. Pocock +21 more
TL;DR: In patients with severe aortic stenosis who were not suitable candidates for surgery, TAVI, as compared with standard therapy, significantly reduced the rates of death from any cause, the composite end point of deathFrom any cause or repeat hospitalization, and cardiac symptoms, despite the higher incidence of major strokes and major vascular events.
Journal ArticleDOI
Guidelines on the management of valvular heart disease The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology
Alec Vahanian,Helmut Baumgartner,Jeroen J. Bax,Butchart Eg,Robert Dion,Gerasimos Filippatos,Frank A. Flachskampf,Roger Hall,Bernard Iung,Jarosław D. Kasprzak,Patrick Nataf,Pilar Tornos,Lucia Torracca,Arnold Wenink,Silvia G. Priori,Jean-Jacques Blanc,Andrzej Budaj,John Camm,Veronica Dean,Jaap W. Deckers,Kenneth Dickstein,John Lekakis,Keith McGregor,Marco Metra,João Morais,Ady Osterspey,Juan Tamargo,José Luis Zamorano,Annalisa Angelini,Manuel J. Antunes,Miguel Ángel García Fernández,Christa Gohlke-Baerwolf,Gilbert Habib,John J.V. McMurray,Catherine M Otto,Luc Pierard,José L. Pomar,Bernard Prendergast,Raphael Rosenhek,Miguel Sousa Uva +39 more
TL;DR: Guidelines and Expert Consensus Documents aim to present management recommendations based on all of the relevant evidence on a particular subject in order to help physicians select the best possible management strategies for the individual patient suffering from a specific condition, taking into account the impact on outcome and also the risk–benefit ratio of a particular diagnostic or therapeutic procedure.
Journal ArticleDOI
European system for cardiac operative risk evaluation (EuroSCORE).
TL;DR: EuroSCORE is a simple, objective and up-to-date system for assessing heart surgery, soundly based on one of the largest, most complete and accurate databases in European cardiac surgical history and is recommend its widespread use.
Journal ArticleDOI
A prospective survey of patients with valvular heart disease in Europe : The Euro Heart Survey on Valvular Heart Disease.
Bernard Iung,Gabriel Baron,Eric G. Butchart,François Delahaye,Christa Gohlke-Bärwolf,Olaf W. Levang,Pilar Tornos,Jean-Louis Vanoverschelde,Frank Vermeer,Eric Boersma,Philippe Ravaud,Alec Vahanian +11 more
TL;DR: Degenerative aetiologies were the most frequent in aortic VHD and mitral regurgitation while most cases of mitral stenosis were of rheumatic origin.
Related Papers (5)
Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery
Martin B. Leon,Craig R. Smith,Michael J. Mack,D. Craig Miller,Jeffrey W. Moses,Lars G. Svensson,E. Murat Tuzcu,John G. Webb,Gregory P. Fontana,Raj Makkar,David L. Brown,Peter C. Block,Robert A. Guyton,Augusto D. Pichard,Joseph E. Bavaria,Howard C. Herrmann,Pamela S. Douglas,John L. Petersen,Jodi J. Akin,William N. Anderson,Duolao Wang,Stuart J. Pocock +21 more
Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients
Craig R. Smith,Martin B. Leon,Michael J. Mack,D. Craig Miller,Jeffrey W. Moses,Lars G. Svensson,E. Murat Tuzcu,John G. Webb,Gregory P. Fontana,Raj Makkar,Mathew R. Williams,Todd M. Dewey,Samir R. Kapadia,Vasilis Babaliaros,Vinod H. Thourani,Paul J. Corso,Augusto D. Pichard,Joseph E. Bavaria,Howard C. Herrmann,Jodi J. Akin,William N. Anderson,Duolao Wang,Stuart J. Pocock +22 more
Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis : Results of the PARTNER (Placement of Aortic Transcatheter Valves) Trial (Cohort A)
Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients.
Martin B. Leon,Craig R. Smith,Michael J. Mack,Michael J. Mack,Rajendra Makkar,Lars G. Svensson,Susheel Kodali,Vinod H. Thourani,Murat Tuzcu,D. Craig Miller,Howard C. Herrmann,Darshan Doshi,David J. Cohen,Augusto D. Pichard,Samir R. Kapadia,Todd M. Dewey,Vasilis Babaliaros,Wilson Y. Szeto,Mathew R. Williams,Dean J. Kereiakes,Alan Zajarias,Kevin L. Greason,Brian Whisenant,Robert W. Hodson,Jeffrey W. Moses,Alfredo Trento,David L. Brown,William F. Fearon,Philippe Pibarot,Rebecca T. Hahn,Wael A. Jaber,William N. Anderson,Maria Alu,John G. Webb +33 more