Cost Effectiveness of Transcatheter Aortic Valve Replacement Compared with Medical Management or Surgery for Patients with Aortic Stenosis

Iannaccone, Andrea; Marwick, Thomas H.

doi:10.1007/s40258-014-0141-6

Cited by 16 publications

(13 citation statements)

References 67 publications

(96 reference statements)

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“…A considerable body of literature is available on the costs of care for TAVR and/or SAVR-patients; however, there are some major limitations: Usually, the length of follow-up in the existing studies is short, and the longer-term follow-up cost estimates are often based on models built from data collected from various sources. Iannaccone and Marwick (2015), for instance, recently reviewed the literature on the cost effectiveness of TAVR and SAVR in recent studies (published between 2012 and 2014) and found a huge range for total follow-up costs for the procedures of $336–$52,529 and $217–$51,992, respectively [46]. …”

Section: Discussionmentioning

confidence: 99%

Two-year post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement in Germany

Kaier

Kampen

Baumbach

et al. 2017

BMC Health Serv Res

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BackgroundThis study presents data on post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement over a two year period.MethodsBased on a prospective clinical trial, post-discharge utilization of health services and status of assistance were collected for 151 elderly patients via 2250 monthly telephone interviews, valued using standardized unit costs and analysed using two-part regression models.ResultsAt month 1 post-discharge, total costs of care are substantially elevated (monthly mean: €3506.7) and then remain relatively stable over the following 23 months (monthly mean: €622.3). As expected, the majority of these costs are related to in-hospital care (~98% in month 1 post-discharge and ~72% in months 2–24). Patients that died during follow-up were associated with substantially higher cost estimates of in-hospital care than those surviving the two-year study period, while patients’ age and other patient characteristics were of minor relevance. Estimated costs of outpatient care are lower at month 1 than during the rest of the study period, and not affected by the event of death during follow-up. The estimated costs of nursing care are, in contrast, much higher in year 2 than in year 1 and differ substantially by gender and type of procedure as well as by patients’ age. Overall, these monthly cost estimates add up to €10,352 for the first and €7467.6 for the second year post-discharge.ConclusionsSubstantial cost increases at month 1 post-discharge and in case of death during follow-up are the main findings of the study, which should be taken into account in future economic evaluations on the topic. Application of standardized unit costs in combination with monthly patient interviews allows for a far more precise estimate of the variability in post-discharge health service utilization in this group of patients than the ones given in previous studies.Trial registrationGerman Clinical Trial Register Nr. DRKS00000797.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2432-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Two-year post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement in Germany

Kaier

Kampen

Baumbach

et al. 2017

BMC Health Serv Res

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“…The evidence for inoperable patients with severe AS is robust for TAVI and favours its use. In one review evaluating 11 studies comparing TAVI with medical therapy, 9 were in favour of TAVI as being cost‐effective . This was defined as an incremental cost‐effectiveness ratio (ICER) of $50 000 USD or less under the willingness‐to‐pay threshold of acceptable cost‐effectiveness in the United States.…”

Section: Cost‐effectivenessmentioning

confidence: 99%

Contemporary review of severe aortic stenosis

Adams

Ashokkumar

Newcomb

et al. 2019

Internal Medicine Journal

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Severe aortic stenosis (AS) is the most common form of valvular heart disease in the developed world with a rising prevalence due to an ageing Australian population. Transcatheter aortic valve implantation (TAVI) offers a less invasive option for the treatment of severe AS with evidence supporting of TAVI compared to medical therapy in inoperable patients, and superior to surgical aortic valve replacement (SAVR) in high-risk patients. Equal outcomes have been observed in all-comer intermediate risk populations. The Heart Team utilises a shared decision-making approach between physicians and surgeons in risk stratifying patients and reduces the intrinsic bias that may occur if decisions are made in isolation. Geriatric assessment is useful in identifying pre-operative frailty, a major risk factor for death post aortic valve intervention. In severe AS, a decision can be made collaboratively to pursue TAVI, SAVR, a Ross Procedure, or conservative management. The learning curve associated with TAVI has improved markedly with overall complication rates decreasing around the world. Contemporary changes in practice such as conscious sedation without general anaesthesia, expedited recovery and early discharge will likely improve cost-effectiveness. In 2018, TAVI is a well-established procedure in Australia that has revolutionised the management of severe AS. In the future with an expanding elderly population, the number of patients to benefit from transcatheter therapies for severe AS is hypothesised to increase 4-10 fold. Heart Team assessment is crucial in patients with severe AS to direct appropriate management. This article is protected by copyright. All rights reserved.

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“…A análise de custo-efetividade (ACE) é utilizada para situações em que as intervenções possuem desfechos clínicos semelhantes, mas se diferenciam nos custos e efeitos clínicos esperados. Ou seja, é um estudo comparativo entre duas ou mais opções terapêuticas com o objetivo de avaliar o impacto das alternativas por meio do confronto dos custos com os desfechos clínicos (MORAES et al, 2006;HOCH;DEWA, 2008;SECOLI et al, 2010;IANNACCONE;MARWICK, 2015). Esta comparação é feita para identificar a opção com melhor custo-efetividade, chamada também de opção custo-efetiva (SECOLI et al, 2010).…”

Section: Iannaccone E Marwick (2015)unclassified

Custo-Efetividade No Tratamento De Estenose Valvar Aórtica: Um Estudo Das Técnicas Bav E Tavi

Roschel

2019

RAHIS

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Doenças cardíacas têm grande impacto no custo total dos hospitais. Com o aumento da expectativa de vida populacional, esta situação tende a se agravar. O objetivo desta pesquisa é analisar o custo-efetividade de duas opções terapêuticas não invasivas para o tratamento da estenose valvar aórtica em pacientes de idade avançada, a valvuloplastia aórtica por balão (BAV) e o implante transcateter de valva aórtica (TAVI). Analisou-se uma amostra de casos do BAV e TAVI obtida entre os beneficiários do plano de saúde do governo do Estado de Santa Catarina, denominado SC-Saúde. Também foram verificados na literatura os desfechos clínicos destes dois tratamentos para confrontar com os resultados desta pesquisa. O TAVI apresentou melhor custo-efetividade em pacientes inoperáveis e com expectativa de vida maior ou igual a 2 anos. Em contrapartida, o BAV apresentou melhor custo-efetividade para pacientes onde a cirurgia convencional não é totalmente descartada ou para pacientes inoperáveis com uma expectativa de vida menor que 2 anos. Portanto, a avaliação do risco e a ponderação da expectativa de vida de cada paciente, são medidas cruciais para direcioná-los aos tratamentos que possam lhes fornecer melhorias na qualidade de vida e na sobrevivência, assegurando o uso sustentável e econômico dos recursos.

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Cost Effectiveness of Transcatheter Aortic Valve Replacement Compared with Medical Management or Surgery for Patients with Aortic Stenosis

Abstract: On the basis of this review, it was ascertained that the details of risk evaluation and patient selection will be critical in understanding how improvements in survival can be used to target the use of TAVR to ensure the cost-effective and sustainable use of resources.

Cited by 16 publications

References 67 publications

Two-year post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement in Germany

Two-year post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement in Germany

Contemporary review of severe aortic stenosis

Custo-Efetividade No Tratamento De Estenose Valvar Aórtica: Um Estudo Das Técnicas Bav E Tavi

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