Cost-Effectiveness of Transcatheter Aortic Valve Replacement

Abstract

Patients with symptomatic aortic stenosis have a poor prognosis, and medical therapy has little, if any, effect on their natural history. Surgical aortic valve replacement (AVR) is risky, yet it appears to be effective in extending life expectancy and reducing symptoms due to aortic stenosis. In this setting, the development of transcatheter AVR appears to be a breakthrough technology, potentially offering the benefits of surgical AVR without the need for an operation.1 Early clinical experience with transcatheter AVR has been promising and set the stage for a randomized trial to provide the definitive test of its efficacy. The concurrent PARTNER (Placement of AoRTic TraNscathetER Valves) trials2,3 compared transcatheter AVR with medical therapy among patients at prohibitive risk of surgery (PARTNER cohort B), and compared transcatheter and surgical AVR among patients at high, but acceptable risk of surgery (PARTNER cohort A). The PARTNER cohort B trial showed that transcatheter AVR reduced mortality by 50% among inoperable patients and also improved quality of life.2 Transcatheter AVR was clearly a great improvement over medical therapy among elderly patients (average age of 83 years) with inoperable aortic stenosis. Article see p 1102 Transcatheter AVR is a successful new medical technology, but new medical technologies are also the prime drivers of increasing medical costs in the United States. Because the rising cost of health care has the potential to bankrupt the country, policymakers rightfully ask for evidence that any new technology provide sufficient clinical value to justify its costs. Cost-effectiveness analysis provides an explicit framework to assess the value of medical interventions. The fundamental principles of cost-effectiveness analysis are simple: How much does the new technology improve clinical outcomes compared with the next best alternative, and how much does it cost compared with the next best alternative? The difference in …