Cost effectiveness of transcatheter aortic valve implantation in patients with aortic stenosis in Japan

Kodera, Satoshi; Kiyosue, Arihiro; Ando, Jiro; Komuro, Issei

doi:10.1016/j.jjcc.2017.10.008

Cited by 23 publications

(32 citation statements)

References 22 publications

(40 reference statements)

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“…Appropriate selection of treatment modality for AS requires discussion of various issues, such as operative mortality, 8 operative morbidity, 9,10 long-term survival and the cardiac event-free rate, 11-13 durability of the prosthetic valve, 14,15 postoperative quality of life, 16 and cost-effectiveness of each treatment. [17][18][19][20] In the present study, we focused on general functional status at discharge and hospitalization period, and investigated the factors that affected these variables. No previous large-scale studies have focused on general status at discharge and hospitalization period.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis　― Risk Model From a Japan Cardiovascular Surgery Database ―

et al. 2019

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Background:The aim of this study was to determine adequate indication for transcatheter aortic valve replacement (TAVR). We analyzed risk factors of surgical aortic valve replacement (SAVR) not only for mortality, but also for morbidity, including long hospital stay (≥90 days) and patient activity at discharge, in patients who underwent SAVR for aortic stenosis (AS). Methods and Results:Using the Japan Adult Cardiovascular Surgery Database (JCVSD), 13,961 patients with or without coronary artery bypass grafting who underwent elective SAVR for AS were identified from January 2008 to December 2012. The hospital mortality rate was 3.1%. The percentage of patients who had long hospital stay (≥90 days) and who had moderately or severely decompressed activity at discharge (modified Rankin scale ≥4) was 2.9% and 6.5%, respectively. Eleven and 20 preoperative predictors of hospital mortality and morbidity, respectively, including long hospital stay and compromised status at discharge, were identified. Based on these risk factors, the risk model predicted hospital mortality (area under the curve [AUC], 0.732) and morbidity (AUC, 0.694). Conclusions:Using JCVSD, a risk model of SAVR was developed for AS. This model can identify patients at high risk not only for mortality, but also for mortality and morbidity, including long hospital stay and status at discharge.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis　― Risk Model From a Japan Cardiovascular Surgery Database ―

et al. 2019

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“…The existing health economic evaluations of TAVI, mainly refer to previous generation valves and are based on the early trials, suggesting a different probability of TAVI being cost-effective depending on the alternatives considered and also on the context explored [11][12][13][14][15][16][17][18]. Indeed, from the very first-generation valve marketed in 2007, devices have been iteratively developed and improved.…”

Section: Introductionmentioning

confidence: 99%

The cost-effectiveness of transcatheter aortic valve implantation: exploring the Italian National Health System perspective and different patient risk groups

Lorenzoni

Barbieri²,

Saia

et al. 2021

Eur J Health Econ

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Objectives To assess the cost-effectiveness (CE) of transcatheter aortic valve implantation (TAVI) in Italy, considering patient groups with different surgical risk. Methods A Markov model with a 1-month cycle length, comprising eight different health states, defined by the New York Heart Association functional classes (NYHA I–IV), with and without stroke plus death, was used to estimate the CE of TAVI for intermediate-, high-risk and inoperable patients considering surgical aortic valve replacement or medical treatment as comparators according to the patient group. The Italian National Health System perspective and 15-year time horizon were considered. In the base-case analysis, effectiveness data were retrieved from published efficacy data and total direct costs (euros) were estimated from national tariffs. A scenario analysis considering a micro-costing approach to estimate procedural costs was also considered. The incremental cost-effectiveness ratio (ICER) was expressed both in terms of costs per life years gained (LYG) and costs per quality adjusted life years (QALY). All outcomes and costs were discounted at 3% per annum. Univariate and probabilistic sensitivity analyses (PSA) were performed to assess robustness of results. Results Over a 15-year time horizon, the higher acquisition costs for TAVI were partially offset in all risk groups because of its effectiveness and safety profile. ICERs were €8338/QALY, €11,209/QALY and €10,133/QALY, respectively, for intermediate-, high-risk and inoperable patients. ICER values were slightly higher in the scenario analysis. PSA suggested consistency of results. Conclusions TAVI would be considered cost-effective at frequently cited willingness-to-pay thresholds; further studies could clarify the CE of TAVI in real-life scenarios.

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“…Transcatheter aortic valve replacement (TAVR) is associated with similar clinical outcomes compared to surgical aortic valve replacement among patients with severe symptomatic AS and a high surgical risk [1]. TAVR also had good cost effectiveness especially for inoperable patients [2]. TAVR is recommended for patients with a life expectancy >1 year who are expected to experience an improved quality of life after the procedure [3].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of objective nutritional status after transcatheter aortic valve replacement

Honda

Yamawaki

Shirai

et al. 2019

Journal of Cardiology

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Background: This study aimed to elucidate the prognostic value of objective nutritional status after transcatheter aortic valve replacement (TAVR). Methods: This study enrolled 150 consecutive patients who underwent TAVR between February 2014 and March 2017. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score before TAVR. Patients were divided into a high CONUT score (malnutrition status >4 points, n = 30) or low CONUT score (normal nutritional status 1-4 points, n = 120) group. The primary endpoint was mortality within 1-year post-TAVR. Results: Patients in the high CONUT group were characterized by low body mass index (kg/m 2 ) (20.3 AE 2.4 vs. 22.8 AE 3.5, p < 0.001), a higher prevalence of atrial fibrillation (43% vs. 23%, p = 0.03), and more common frailty [median (interquartile range) Clinical Frailty Scale (CFS) score, 4.5 (3.75-6) vs. 4 (3-5), p < 0.001]. Mortality rate within 1-year post-TAVR was significantly higher in the high CONUT group (43.6% vs. 6.7%, p < 0.001). High CONUT score was independently associated with poor prognosis post-TAVR [adjusted hazard ratio, 8.20; 95% confidence interval (CI), 3.10-22.6; p < 0.001]. On integrated discrimination improvement (IDI) analysis, malnutrition status improved CFS for predicting mortality post-TAVR (IDI, 0.15; 95% CI, 0.07-0.23; p < 0.001). Conclusions: Objective malnutrition status was predictive of mortality post-TAVR and provided complementary prognostic information to the CFS. Thus, objective nutritional status may refine the clinical risk stratification of patients who undergo TAVR.

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Cost effectiveness of transcatheter aortic valve implantation in patients with aortic stenosis in Japan

Abstract: This study suggests that TAVI has good cost effectiveness for inoperable patients, but not for operable patients.

Cited by 23 publications

References 22 publications

Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis　― Risk Model From a Japan Cardiovascular Surgery Database ―

Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis　― Risk Model From a Japan Cardiovascular Surgery Database ―

The cost-effectiveness of transcatheter aortic valve implantation: exploring the Italian National Health System perspective and different patient risk groups

Prognostic value of objective nutritional status after transcatheter aortic valve replacement

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Cost effectiveness of transcatheter aortic valve implantation in patients with aortic stenosis in Japan

Abstract: This study suggests that TAVI has good cost effectiveness for inoperable patients, but not for operable patients.

Cited by 23 publications

References 22 publications

Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis ― Risk Model From a Japan Cardiovascular Surgery Database ―

Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis ― Risk Model From a Japan Cardiovascular Surgery Database ―

The cost-effectiveness of transcatheter aortic valve implantation: exploring the Italian National Health System perspective and different patient risk groups

Prognostic value of objective nutritional status after transcatheter aortic valve replacement

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Product

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Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis　― Risk Model From a Japan Cardiovascular Surgery Database ―

Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis　― Risk Model From a Japan Cardiovascular Surgery Database ―