PMD65 - Cost-Effectiveness of Transcathether Aortic Valve Implantation with the New Repositionable Self-Expandable Evolut R Versus Corevalve System in Inoperable Patients with Severe Aortic Stenosis in Mexico

Abstract

To assess the cost-effectiveness of the transcathether aortic valve implantation with the new repositionable self-expandable Evolut R versus CoreValve system, for patients with severe aortic stenosis and high surgical risk in Mexico After a systematic review on MEDLINE, EMBASE, The Cochrane Library, Health Technology Assessment (HTA), Database of Abstracts of Reviews of Effects (DARE) and NHS Economic Evaluation Database (EED), a single paper was identified as the main input. We developed a cost-effectiveness evaluation, through a decision tree model, from the public-sector perspective. A post-surgery time horizon (in- hospital days after surgery) was considered. Health effect was measured based on the probability of in-hospital survival; with a scenario sensitivity analysis (SSA) at 30 and 365 days. We estimated direct medical costs (intervention and adverse events) from official sources (diagnosis-related group and unit costs from "Instituto Mexicano de la Seguridad Social"). Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) was performed to evaluate uncertainty levels. Our model show Evolut ™ R as a dominant option vs CoreValve ™, with an incremental effectiveness of 0.023 extra survival probability (ESP) and cost savings of $3,653.00 USD ($ 68,712.98 MXN) for the post-surgery scenario; in SSA at 30 and 365 days ESP were 0.062 and 0.061 respectively. The most influential variables in the incremental cost effectiveness ratio (ICER) at DSA are the price of Evolut ™ R and the moderate or severe paravalvular leak. PSA through 1000 iterations illustrate that in 90% of them, Evolut ™ R remains as a cost-effective option. In a Life-threatening disease, as an inoperable patient with severe aortic stenosis, E Evolut ™ R provided meaningful clinical benefits and cost savings, compared with CoreValve, with incremental costs considered within acceptable threshold by Mexico authorities.