Cost-effectiveness Of Aortic Valve Replacement Research Articles

Cost-Effectiveness of Transcatheter Aortic Valve Replacement: Current Decision-Analytic Models and Future Opportunities

Transcatheter aortic valve replacement (TAVR) is an important new therapy approach for the treatment of severe aortic stenosis. Our objective was to identify and review the growing body of published cost-effectiveness analyses of TAVR, and to identify opportunities for future modeling and analyses in light of new clinical evidence. A systematic search in PubMed, Embase, and HTA agency databases and a grey search were conducted for the period from 2005 through 2014 to identify studies examining the cost-effectiveness of aortic valve replacement using a transcatheter-based intervention. Searches, study selection, and data extraction were performed according to a predefined protocol. We only included studies on cost-effectiveness of TAVR compared with either medical management (MM) or surgery (SAVR). Appraised studies were analyzed using the CHEERS checklist. Our search yielded n=15 studies, comprising 13 distinct decision-analytic models set in six countries: Belgium, Brazil, Canada, Spain, United Kingdom, and U.S.A. Four of the models were developed by national HTA agencies or academic groups. In some cases, HTA reports differed from the published results. Study quality per CHEERs criteria was poor to excellent. n=7 models compared TAVR to medical management, two to surgery, and n=5 evaluated the cost-effectiveness of TAVR in comparison to both. n=13 studies utilized efficacy data from PARTNER A and B. Only one study used patient-level data in an “along-the-trial” design. ICER in studies comparing TAVR to MM ranged from £12,600 to US$115,600 per QALYs. Compared with SAVR, ICER estimates ranged from TAVR dominating to being dominated. Economic evaluations are lagging behind published clinical evidence. Future opportunities include economic evaluation of newer clinical trial data, long-term follow-up data from earlier studies, and more explicit evaluation of subsets of patient cohorts. Overall model quality and reporting of methods including data sources could be improved further.

Cost-effectiveness of aortic valve replacement in the elderly: An introductory study

With increased life expectancy and improved technology, valve replacement is being offered to increasing numbers of elderly patients with satisfactory clinical results. By using standard econometric techniques, we estimated the relative cost-effectiveness of aortic valve replacement by drawing on a large prospective database at our institution. By using aortic valve replacement as an example, this introductory report paves the way to more definitive studies of these issues in the future. From 1961 to 2003, 4617 adult patients underwent aortic valve replacement at our service. These patients were provided with a prospective lifetime follow-up. As of 2005, these patients had accumulated 31,671 patient-years of follow-up (maximum 41 years) and had returned 22,396 yearly questionnaires. A statistical model was used to estimate the future life years of patients who are currently alive. In the absence of direct estimates of utility, quality-adjusted life years were estimated from New York Heart Association class. The cost-effectiveness ratio was calculated by the patient's age at surgery. The overall cost-effectiveness ratio was approximately 13,528 dollars per quality-adjusted life year gained. The cost-effectiveness ratio increased according to age at surgery, up to 19,826 dollars per quality-adjusted life year for octogenarians and 27,182 dollars per quality-adjusted life year for nonagenarians. Given the limited scope of this introductory study, aortic valve replacement is cost-effective for all age groups and is very cost-effective for all but the most elderly according to standard econometric rules of thumb.

Natural history of valvular heart disease.

HomeCirculationVol. 65, No. 6Natural history of valvular heart disease. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBNatural history of valvular heart disease. F E Kloster and C D Morris F E KlosterF E Kloster Search for more papers by this author and C D MorrisC D Morris Search for more papers by this author Originally published1 Jun 1982https://doi.org/10.1161/01.CIR.65.6.1283Circulation. 1982;65:1283–1285 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Wu Y, Jin R, Gao G, Grunkemeier G and Starr A (2007) Cost-effectiveness of aortic valve replacement in the elderly: An introductory study, The Journal of Thoracic and Cardiovascular Surgery, 10.1016/j.jtcvs.2006.10.044, 133:3, (608-613), Online publication date: 1-Mar-2007. June 1, 1982Vol 65, Issue 6 Advertisement Article InformationMetrics Copyright © 1982 by American Heart Associationhttps://doi.org/10.1161/01.CIR.65.6.1283 Originally publishedJune 1, 1982 PDF download Advertisement