Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk
Authors Povero M, Miceli A, Pradelli L, Ferrarini M, Pinciroli M, Glauber M
Received 29 August 2018
Accepted for publication 25 September 2018
Published 8 November 2018 Volume 2018:10 Pages 733—745
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Professor Samer Hamidi
Massimiliano Povero,1 Antonio Miceli,2,3 Lorenzo Pradelli,1 Matteo Ferrarini,2 Matteo Pinciroli,4 Mattia Glauber2
1AdRes Health Economics and Outcomes Research, Turin, Italy; 2Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant’Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy; 3Bristol Heart Institute, University of Bristol, Bristol, UK; 4LivaNova, Milan, Italy
Background: Meta-analyses of studies comparing transcatheter aortic valve implants (TAVIs) and sutureless aortic valve replacement (SU-AVR) show differing effectiveness and safety profiles. The approaches also differ in their surgical cost (including operating room and device).
Objective: The objective of this study was to assess the incremental cost-utility of SU-AVR vs TAVIs for the treatment of intermediate- to high-risk patients in the US, Germany, France, Italy, UK, and Australia.
Methods: A patient-level simulation compares in-hospital pathways of patients undergoing SU-AVR or TAVIs; later, patient history is modeled at the cohort level. Hospital outcomes for TAVIs reproduce data from recent series; in SU-AVR patients, outcomes are obtained by applying relative efficacy estimates in a recent meta-analysis on 1,462 patients. After discharge, survival depends on the development of paravalvular leak and the need for dialysis. A comprehensive third-party payer perspective encompassing both in-hospital and long-term costs was adopted.
Results: Due to lower in-hospital (4.1% vs 7.0%) and overall mortality, patients treated with SU-AVR are expected to live an average of 1.25 years more compared with those undergoing TAVIs, with a mean gain of 1.14 quality-adjusted life-years. Both in-hospital and long-term costs were lower for SU-AVR than for TAVIs with total savings ranging from $4,158 (France) to $20,930 (US).
Conclusion: SU-AVR results dominant when compared to TAVIs in intermediate- to high-risk patients. Both in-hospital and long-term costs are lower for SU-AVR than for TAVI patients, with concomitant significant gains in life expectancy, both raw and adjusted for the quality of life.
Keywords: sutureless valve, aortic valve replacement, TAVI, DES model, cost-utility
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