PMD84 Cost-Effectiveness of Transcatheter Aortic Valve Replacement: Current Decision-Analytic Models and Future Opportunities

R Busca, BP Geisler, JB Pietzsch

Research output: Contribution to journalArticle

Abstract

Objectives

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.
Methods

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.
Results

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.
Conclusions

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.
Original languageEnglish
Pages (from-to)A359
Number of pages1
JournalValue in Health
Volume18
Issue number7
DOIs
Publication statusPublished - 1 Nov 2015
Externally publishedYes

Keywords

  • transcatheter aortic valve replacement
  • Cost-effectiveness
  • economic evaluations

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