The Cost-Effectiveness of Transcatheter Aortic Valve Replacement for Nonsurgical Candidates

Abstract

> Prediction is very difficult, especially if it’s about the future > > Neils Bohr Life expectancy in the United States has steadily increased in the past century, from just <60 years in 1930, to just <70 years in 1960, and to just <80 years in 2010. Progress, however, has its price. The numbers of elderly and very elderly members of the population in the United States and other developed nations are increasing rapidly along with their age-related health problems. At the same time, healthcare spending has risen dramatically. As new medical treatments have become more expensive to discover and produce, and the incremental benefits those treatments provide have become smaller, there is a growing perception that the return on continued increases in healthcare spending may be diminishing.1 Article see p 419 Into this milieu enters transcatheter aortic valve replacement (TAVR), a therapy that is currently revolutionizing the approach to managing aortic stenosis (AS)—a condition, mainly, of the elderly. Cohort B of the Placement of Aortic Transcatheter Valves (PARTNER) trial,2 along with a number of nonrandomized studies, has shown that TAVR can greatly improve health outcomes in the important minority of patients with severe AS who are felt to be at prohibitive risk for surgical intervention. In this setting, TAVR reduced all-cause mortality by absolute margins of 20% and 25% at 1 and 2 years, respectively, while substantially improving functional status and quality of life, compared with medical management.2–4 Although the clinical benefits of TAVR for the inoperable population are unquestionably large, so too are the financial costs, not only of the treatment itself but also for the ongoing medical care of patients who are, on average, octogenarians with complex medical problems. Consequently, payers in varied settings have needed to carefully examine the affordability and value of TAVR …