PCV110 COST-EFFECTIVENESS OF SUTURELESS AORTIC VALVE REPLACEMENT VERSUS CONVENTIONAL AORTIC VALVE REPLACEMENT AND TRANSCATHETER AORTIC VALVE IMPLANTATION IN BRAZIL

Abstract

Sutureless aortic valve replacement (SAVR) is indicated for patients with aortic stenosis. The aim of this study is to explore the cost-effectiveness (CEA)of SAVR versus relevant comparators in the Brazilian private health care setting. Three treatment modalities for aortic stenosis: SAVR, conventional aortic valve replacement (CAVR) and transcatheter aortic valve implantation (TAVI) were compared in the CEA.. In line with the Valve Academic Research Consortium-2 Guidelines the time horizon chosen was 30 days. The probabilities (30-day mortality, paravalvular regurgitation, arrhythmia, acute kidney injury and other relevant outcomes) were identified via a systematic review and network meta-analysis on randomized trials and propensity score matched cohort studies. Predicted 30-day mortality outcome was reported as odds ratio and 95% confidence intervals. The costs (ex.: cost of device, dialysis, bleeding and complications related costs) were retrieved from standardized tables such as CBHPM, CMED and SIMPRO. Probabilities and costs were modelled as beta and gamma distributions in a decision tree model. A probabilistic sensitivity analysis was performed to assess uncertainty. TAVI overall costs were higher than SAVR and CAVR at R$ 78451.07. SAVR costs (R$ 50743.95) were comparable to CAVR (R$ 50136.89). The network meta-analysis results showed that, SAVR was associated with a lower probabilistic rate of death (2.3%) compared to CAVR (4.5%) and TAVI (4.4%), suggesting that SAVR is associated with better survival. The incremental cost-effectiveness ratio (ICER) between SAVR and CAVR was R$ 27593.42 death avoided and, in comparison to TAVI, SAVR was dominant. In the Brazilian private health care setting, SAVR was associated with the best 30-day survival probability profile between the three alternatives, whereas TAVI was the most expensive therapy. The proposed economic model suggests that SAVR is dominant over TAVI and is likely to be a highly cost-effective treatment alternative when compared to CAVR.