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Chotnoppharatphatthara P, Yoodee V, Taesotikul S, Yadee J, Permsuwan U. Transcatheter aortic valve implantation in patients with severe symptomatic aortic valve stenosis: systematic review of cost-effectiveness analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:359-376. [PMID: 35708785 DOI: 10.1007/s10198-022-01477-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a less invasive and costly treatment for patients with severe aortic stenosis (AS). This study aimed to systematically review the published literature focusing on economic evaluation of TAVI compared with other alternative treatments in AS populations. METHODS A systematic review was conducted from inception until May 2021 using PubMed, Scopus, Web of science and Embase databases. The qualities of included studies were evaluated using Consolidated Health Economic Evaluation Reporting Standard (CHEERS) criteria. Data of costs, outcomes, incremental cost-effectiveness ratio (ICER) and willingness to pay were extracted. To compare results, ICERs were converted to the 2020 United States dollar (USD) rate. RESULTS Of the 29 included cost-effectiveness studies, TAVI was cost-effective in all studies in the low-risk group (3/3), 77% of studies (7/9) in the intermediate-risk group, half of the studies (6/12) in the high-risk group, and 83% of studies (10/12) in the inoperable group. When adjusted to USD 2020, ICERs ranged from USD 2741 to 1027,674 USD per quality-adjusted life-year gained. The overall quality of the studies ranged from moderate to high. CONCLUSIONS TAVI is potentially a cost-effective alternative to surgical aortic valve replacement (SAVR) for patients with operable AS with low, intermediate or high risk compared with medical management (MM) for patients with inoperable AS. TAVI was associated with a significant gain in quality-adjusted life-years in almost all studies compared to either SAVR or MM. TAVI is a costly procedure; therefore, justifying its cost-effectiveness depends on the acceptable threshold in each country.
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Affiliation(s)
| | - Voratima Yoodee
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
- Pharmaceutical Care Training Center (PCTC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Suthinee Taesotikul
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
- Pharmaceutical Care Training Center (PCTC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Jirawit Yadee
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
- Center for Medical and Health Technology Assessment (CM-HTA), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Unchalee Permsuwan
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.
- Center for Medical and Health Technology Assessment (CM-HTA), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Petrou P. The economics of TAVI: A systematic review. IJC HEART & VASCULATURE 2023; 44:101173. [PMID: 36747880 PMCID: PMC9898648 DOI: 10.1016/j.ijcha.2023.101173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023]
Abstract
Objective The scope of this systematic review is to update the existing body of evidence regarding the cost-effectiveness of transcatheter aortic valve implantation, stratified across all risk categories, and to assess their methodological quality. Methods A systematic review was performed including published cost-effectiveness analyses of heart valve implantations. The quality was assessed with the Quality of Health Economics Tool. Results We identified 33 economic evaluations of transcatheter aortic heart valve implantations. Results were not consistent, ranging from dominant to dominating. Moreover, the models were sensitive to an array of variables. The methodological quality of the studies was good. Conclusion This systematic review led to inconclusive and inconsistent results pertinent to the economic profile of TAVI technology. It also highlighted areas which merit further research regarding the pillars of cost-effectiveness analysis such as modeling, the extrapolation of available data and the uncertainty of the evidence. A thorough assessment of the patient should proceed any decision-making.
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Affiliation(s)
- Panagiotis Petrou
- University of Nicosia, School of Sciences and Engineering, Pharmacy School, Pharmacoepidemiology-Pharmacovigilance, Nicosia, Cyprus,University of Nicosia, Department of Life and Health Sciences, School of Sciences and Engineering, Pharmacoepidemiology-Pharmacovigilance, Nicosia, Cyprus
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Pinar E, García de Lara J, Hurtado J, Robles M, Leithold G, Martí-Sánchez B, Cuervo J, Pascual DA, Estévez-Carrillo A, Crespo C. Análisis coste-efectividad del implante percutáneo de válvula aórtica SAPIEN 3 en pacientes con estenosis aórtica grave sintomática. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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The transcatheter aortic valve implantation: an assessment of the generalizability of the economic evidences following a systematic review. Int J Technol Assess Health Care 2022; 38:e27. [PMID: 35321767 DOI: 10.1017/s0266462321001720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Scientific literature debates on the economic affordability of transcatheter aortic valve implantation (TAVI) in order to give a useful support to decision makers aiming at establishing a reimbursement scheme for TAVI. For this reason, it is important to assess the quality and the generalizability of the existing economic evidences. METHODS The first step was to run a literature search according to a predefined population, intervention, comparator, and outcome on the cost and effectiveness of the TAVI procedure in comparison to medical therapy and traditional surgery. Second, a manual search was carried out on the Web sites of the main HTA agencies. Third, the checklist developed by Augustovski et al. was applied in order to assess the quality and the generalizability of the articles resulting from the selection process. RESULTS Overall, 106 articles were obtained. Of these, sixty-five articles were excluded since the title was not consistent with the objective. Further selection took place after abstract and full-text reading. In the end, thirty-one documents were included for the review. According to the checklist, none of the articles was considered generalizable and only one was considered transferable which compares the TAVI procedure with Medical Management in inoperable patients. CONCLUSIONS Despite the overall quality of the selected studies was considered good, there is still a lack of evidence on whether evidences generated in different contexts can be considered generalizable. Further research on resource consumption and preferences is needed in order to provide decision makers with more robust evidences.
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Patlolla SH, Schaff HV, Dearani JA, Stulak JM, Crestanello JA, Greason KL. Aortic Stenosis and Coronary Artery Disease: Cost of Transcatheter versus Surgical Management. Ann Thorac Surg 2021; 114:659-666. [PMID: 34560043 DOI: 10.1016/j.athoracsur.2021.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/12/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical aortic valve replacement with coronary artery bypass grafting (SAVR+CABG) is the recommended treatment for aortic stenosis (AS) and coronary artery disease (CAD), however percutaneous coronary intervention at the time of transcatheter aortic valve replacement (TAVR+PCI) is used with increasing frequency. METHODS Using the National Inpatient Sample, we identified all adult admissions with a diagnosis of AS. Sub-groups of SAVR+CABG and TAVR+PCI formed the study group. Outcomes of interest included total hospitalization charges, temporal trends, in-hospital mortality, and complications. RESULTS Between 2012 and 2017, a total of 97,955 (95.9%) admissions received SAVR+CABG, and 4240 (4.1%) received TAVR+PCI; the proportion of TAVR+PCI increased from 1.0% in 2012 to 9.2% in 2017 (p<0.001). Compared to those receiving TAVR+PCI, admissions receiving SAVR+CABG were younger, more likely to be male, and had lower comorbidity (all p<0.001). Adjusted in-hospital mortality was comparable in both groups (OR 0.94, 95% CI 0.79-1.11, p=0.45). Higher rates of pacemaker implantation, cardiac arrest, and vascular complications were seen in the TAVR+PCI group, while SAVR+CABG was associated with a greater requirement of prolonged ventilation. Admissions receiving TAVR+PCI had shorter lengths of hospital stay and were more likely to be discharged home. Nevertheless, TAVR+PCI had higher hospitalization charges compared to SAVR+CABG group (all p<0.001). CONCLUSIONS There has been a steady increase in the utilization of percutaneous strategies for AS and CAD management. In-hospital mortality was comparable in SAVR+CABG and TAVR+PCI groups, but despite shorter in-hospital stays, TAVR+PCI was associated with higher cardiac and vascular complication rates and hospitalization charges.
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Affiliation(s)
| | | | | | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
| | | | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
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Charlesworth M, Williams BG, Buch MH. Advances in transcatheter aortic valve implantation, part 2: perioperative care. BJA Educ 2021; 21:264-269. [PMID: 34178383 DOI: 10.1016/j.bjae.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- M Charlesworth
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - B G Williams
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M H Buch
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Pinar E, García de Lara J, Hurtado J, Robles M, Leithold G, Martí-Sánchez B, Cuervo J, Pascual DA, Estévez-Carrillo A, Crespo C. Cost-effectiveness analysis of the SAPIEN 3 transcatheter aortic valve implant in patients with symptomatic severe aortic stenosis. ACTA ACUST UNITED AC 2021; 75:325-333. [PMID: 34016548 DOI: 10.1016/j.rec.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/15/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter aortic valve implant has become a widely accepted treatment for inoperable patients with aortic stenosis and patients at high surgical risk. Its indications have recently been expanded to include patients at intermediate and low surgical risk. Our aim was to evaluate the efficiency of SAPIEN 3 vs conservative medical treatment (CMT) or surgical aortic valve replacement (SAVR) in symptomatic inoperable patients at high or intermediate risk. METHODS We conducted a cost-effectiveness analysis of SAPIEN 3 vs SAVR/CMT, using a Markov model (monthly cycles) with 8 states defined by the New York Heart Association and a time horizon of 15 years, including major complications and management after hospital discharge, from the perspective of the National Health System. Effectiveness parameters were based on the PARTNER trials. Costs related to the procedure, hospitalization, complications, and follow-up were included (euros in 2019). An annual discount rate of 3% was applied to both costs and benefits. Deterministic and probabilistic sensitivity analyses (Monte Carlo) were performed. RESULTS Compared with SAVR (high and intermediate risk) and CMT (inoperable), SAPIEN 3 showed better clinical results in the 3 populations and lower hospital stay. Incremental cost-utility ratios (€/quality-adjusted life years gained) were 5471 (high risk), 8119 (intermediate risk) and 9948 (inoperable), respectively. In the probabilistic analysis, SAPIEN 3 was cost-effective in more than 75% of the simulations in the 3 profiles. CONCLUSIONS In our health system, SAPIEN 3 facilitates efficient management of severe aortic stenosis in inoperable and high- and intermediate-risk patients.
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Affiliation(s)
- Eduardo Pinar
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
| | - Juan García de Lara
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - José Hurtado
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Miguel Robles
- Servicio de Contabilidad de Ingresos y Gastos, Servicio Murciano de Salud, Murcia, Spain
| | - Gunnar Leithold
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Jesús Cuervo
- Axentiva Solutions, Santa Cruz de Tenerife, Spain
| | - Domingo A Pascual
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Carlos Crespo
- Axentiva Solutions, Santa Cruz de Tenerife, Spain; Departamento de Genética, Microbiología y Estadística, Universidad de Barcelona, Barcelona, Spain
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Enzing JJ, Vijgen S, Knies S, Boer B, Brouwer WB. Do economic evaluations of TAVI deal with learning effects, innovation, and context dependency? A review. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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TAVR, SAVR and MI-AVR. Good Things Come to Those Who Wait. J Clin Med 2020; 9:jcm9113392. [PMID: 33113889 PMCID: PMC7690667 DOI: 10.3390/jcm9113392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/16/2022] Open
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Goldsweig AM, Tak HJ, Chen LW, Aronow HD, Shah B, Kolte D, Desai NR, Szerlip M, Velagapudi P, Abbott JD. Relative Costs of Surgical and Transcatheter Aortic Valve Replacement and Medical Therapy. Circ Cardiovasc Interv 2020; 13:e008681. [DOI: 10.1161/circinterventions.119.008681] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The number of patients treated for aortic valve disease in the United States is increasing rapidly. Transcatheter aortic valve replacement (TAVR) is supplanting surgical aortic valve replacement (SAVR) and medical therapy (MT). The economic implications of these trends are unknown. Therefore, we undertook to determine the costs, inpatient days, and number of admissions associated with treating aortic valve disease with SAVR, TAVR, or MT.
Methods:
Using the Nationwide Readmissions Database, we identified patients with aortic valve disease admitted 2012 to 2016 for SAVR, TAVR, and disease symptoms (congestive heart failure, unstable angina, non–ST-elevation myocardial infarction, syncope). Patients not undergoing SAVR or TAVR were classified as receiving MT. Beginning with the index admission, we estimated inpatient costs, days, and admissions over 6 months.
Results:
Among 190 563 patients with aortic valve disease, the average aggregate 6-month inpatient costs were $59 743 for SAVR, $64 395 for TAVR, and $23 460 for MT. Mean index admission was longer for SAVR (10.0 days) than for TAVR (7.0 day) or MT (5.3 days), but the average number of unplanned readmission inpatient days was 2.0 for SAVR, 3.0 for TAVR, and 4.3 for MT; the average number of total admissions was 1.3 for SAVR, 1.5 for TAVR, and 1.7 for MT (
P
<0.01 for all). TAVR index admission costs decreased over time to become similar to SAVR costs by 2016.
Conclusions:
Aggregate costs were higher for TAVR than SAVR and were significantly more expensive than MT alone. However, TAVR costs decreased over time while SAVR and MT costs remained unchanged.
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Affiliation(s)
- Andrew M. Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha. (A.M.G., P.V.)
| | - Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha. (H.J.T., L.-W.C.)
| | - Li-Wu Chen
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha. (H.J.T., L.-W.C.)
| | - Herbert D. Aronow
- Division of Cardiovascular Medicine, Lifespan Cardiovascular Institute, Brown University, Providence, RI (H.D.A., J.D.A.)
| | - Binita Shah
- Division of Cardiology, VA New York Harbor Healthcare and New York University School of Medicine (B.S.)
| | - Dhaval Kolte
- Division of Cardiovascular Medicine, Harvard University, Massachusetts General Hospital, Boston (D.K.)
| | - Nihar R. Desai
- Division of Cardiovascular Medicine, Yale University, Yale New Haven Hospital, New Haven, CT (N.R.D.)
| | - Molly Szerlip
- Department of Interventional Cardiology, The Heart Hospital, Baylor Plano, Plano, TX (M.S.)
| | - Poonam Velagapudi
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha. (A.M.G., P.V.)
| | - J. Dawn Abbott
- Division of Cardiovascular Medicine, Lifespan Cardiovascular Institute, Brown University, Providence, RI (H.D.A., J.D.A.)
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Inoue S, Nakao K, Hanyu M, Hayashida K, Shibahara H, Kobayashi M, Asaoka M, Nishikawa K, Clancy S, Koshiishi J, Sakamaki H. Cost-Effectiveness of Transcatheter Aortic Valve Implantation Using a Balloon-Expandable Valve in Japan: Experience From the Japanese Pilot Health Technology Assessment. Value Health Reg Issues 2020; 21:82-90. [DOI: 10.1016/j.vhri.2019.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/30/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022]
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The learning curve in transcatheter aortic valve implantation clinical studies: A systematic review. Int J Technol Assess Health Care 2020; 36:152-161. [DOI: 10.1017/s0266462320000100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BackgroundTranscatheter aortic-valve implantation (TAVI) has become an essential alternative to surgical aortic-valve replacement in the treatment of symptomatic severe aortic stenosis, and this procedure requires technical expertise. The aim of this study was to identify prospective studies on TAVI from the past 10 years, and then to analyze the quality of information reported about the learning curve.Materials and methodsA systematic review of articles published between 2007 and 2017 was performed using PubMed and the EMBASE database. Prospective studies regarding TAVI were included. The quality of information reported about the learning curve was evaluated using the following criteria: mention of the learning curve, the description of a roll-in phase, the involvement of a proctor, and the number of patients suggested to maintain skills.ResultsA total of sixty-eight studies met the selection criteria and were suitable for analysis. The learning curve was addressed in approximately half of the articles (n = 37, 54 percent). However, the roll-in period was mentioned by only eight studies (12 percent) and with very few details. Furthermore, a proctorship was disclosed in three articles (4 percent) whereas twenty-five studies (37 percent) included authors that were proctors for manufacturers of TAVI.ConclusionMany prospective studies on TAVI over the past 10 years mention learning curves as a core component of successful TAVI procedures. However, the quality of information reported about the learning curve is relatively poor, and uniform guidance on how to properly assess the learning curve is still missing.
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Reemplazo valvular aórtico con bioprótesis sin sutura Perceval S: experiencia de un solo centro. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chopra M, Luk NHV, De Backer O, Søndergaard L. Simplification and optimization of transcatheter aortic valve implantation - fast-track course without compromising safety and efficacy. BMC Cardiovasc Disord 2018; 18:231. [PMID: 30526521 PMCID: PMC6288866 DOI: 10.1186/s12872-018-0976-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/03/2018] [Indexed: 01/09/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become an established therapeutic option for patients with symptomatic, severe aortic valve stenosis. Ageing of the Western and Asian population and expansion of indications for TAVI will lead to a substantial increase in the number of TAVI procedures performed worldwide within the next decades. In line with the maturation of TAVI over the past few years, there has also been a significant simplification and optimisation of the TAVI procedure. A minimalist TAVI procedure and fast-track TAVI course have been shown to have distinct advantages over the more traditional TAVI approach. The aim of this manuscript is to discuss strategies of TAVI simplification and optimization, with special focus on fast-track TAVI, without compromising safety and efficacy.
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Affiliation(s)
- Manik Chopra
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Ngai H V Luk
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Ribera A, Slof J, Ferreira-González I, Serra V, García-Del Blanco B, Cascant P, Andrea R, Falces C, Gutiérrez E, Del Valle-Fernández R, Morís-de laTassa C, Mota P, Oteo JF, Tornos P, García-Dorado D. The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:945-956. [PMID: 29170843 DOI: 10.1007/s10198-017-0941-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. METHODS This is a cost-utility analysis from the perspective of the Spanish National Health Service. Results of two prospective hospital registries (158 and 273 consecutive patients) were incorporated into a probabilistic Markov model to compare quality adjusted life years (QALYs) and costs for TAVR after waiting for 3-12 months, relative to immediate TAVR. We simulated a cohort of 1000 patients, male, and 80 years old; other patient profiles were assessed in sensitivity analyses. RESULTS As waiting time increased, costs decreased at the expense of lower survival and loss of QALYs, leading to incremental cost-effectiveness ratios for eliminating waiting lists of about 12,500 € per QALY. In subgroup analyses prioritization of patients for whom higher benefit was expected led to a smaller loss of QALYs. Concerning budget impact, long waiting lists reduced spending considerably and permanently. CONCLUSIONS A shorter waiting time is likely to be cost-effective (considering commonly accepted willingness-to-pay thresholds in Europe) relative to 3 months or longer waiting periods. If waiting lists are nevertheless seen as unavoidable due to severe but temporary budgetary restrictions, prioritizing patients for whom higher benefit is expected appears to be a way of postponing spending without utterly sacrificing patients' survival and quality of life.
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Affiliation(s)
- Aida Ribera
- Cardiovascular Clinical Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Cardiology Department (CIBERCV), University Hospital Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - John Slof
- Department of Business, Universitat Autònoma de Barcelona, B2, Av. de l'Eix Central, s/n, 08193 Cerdanyola del Vallès, Barcelona, Spain
| | - Ignacio Ferreira-González
- Cardiovascular Clinical Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Cardiology Department (CIBERCV), University Hospital Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Vicente Serra
- Cardiology Department (CIBERCV), University Hospital Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Bruno García-Del Blanco
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Purificació Cascant
- Cardiovascular Clinical Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Rut Andrea
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Carlos Falces
- Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Enrique Gutiérrez
- Cardiology Department, Departamento de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Raquel Del Valle-Fernández
- Unidad de Hemodinamica y Cardiología Intervencionista, Area del Corazón, Hospital Universitario Central de Asturias, Av. De Roma, 33011, Oviedo, Asturias, Spain
| | - César Morís-de laTassa
- Unidad de Hemodinamica y Cardiología Intervencionista, Area del Corazón, Hospital Universitario Central de Asturias, Av. De Roma, 33011, Oviedo, Asturias, Spain
| | - Pedro Mota
- Servicio de Cardiología, ICICOR, Hospital Clínico Universitario, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain
| | - Juan Francisco Oteo
- Servicio de Cardiología, Hospital Puerta de Hierro, C/Manuel de Falla, 1, Majadahonda, 28222, Madrid, Spain
| | - Pilar Tornos
- Cardiology Department (CIBERCV), University Hospital Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - David García-Dorado
- Cardiology Department (CIBERCV), University Hospital Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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Wolf S, Fischer S. Systematische Übersichtsarbeit: Aussagekraft und Übertragbarkeit der Ergebnisse gesundheitsökonomischer Evaluationen zum perkutanen Aortenklappenersatz. Wien Med Wochenschr 2018; 169:293-303. [DOI: 10.1007/s10354-018-0656-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/07/2018] [Indexed: 11/29/2022]
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17
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Martín Gutiérrez E, Martínez Comendador JM, Gualis Cardona J, Maiorano P, Castillo Pardo L, Cuellas Ramón C, Fernández Vázquez F, Castaño Ruiz M. Implante valvular aórtico transcatéter frente a sustitución valvular aórtica en pacientes de riesgo quirúrgico intermedio. Revisión bibliográfica y metaanálisis. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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18
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Ferket BS, Oxman JM, Iribarne A, Gelijns AC, Moskowitz AJ. Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies. J Thorac Cardiovasc Surg 2018; 155:1671-1681.e11. [PMID: 29338858 PMCID: PMC6497446 DOI: 10.1016/j.jtcvs.2017.11.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Bart S Ferket
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jonathan M Oxman
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Iribarne
- Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, One Medical Center Drive, Lebanon, NH
| | - Annetine C Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alan J Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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Gialama F, Prezerakos P, Apostolopoulos V, Maniadakis N. Systematic review of the cost-effectiveness of transcatheter interventions for valvular heart disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 4:81-90. [DOI: 10.1093/ehjqcco/qcx049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/06/2018] [Indexed: 11/14/2022]
Affiliation(s)
- Fotini Gialama
- Department of Health Services Management, National School of Public Health, 196 Alexandras Avenue; 115 21 Athens, Greece
| | - Panagiotis Prezerakos
- Department of Nursing Studies, University of Peloponnese, Efstathiou & Stamatikis Valioti and Plateon, 23100 Sparti, Greece
| | - Vasilis Apostolopoulos
- Administration, Athens Medical Group, Filadelfeos & Kefalariou 1, Square Kefalariou, 14562 Kifisia, Athens, Greece
| | - Nikolaos Maniadakis
- Department of Health Services Management, National School of Public Health, 196 Alexandras Avenue; 115 21 Athens, Greece
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Aortic Valve Replacement With Perceval Bioprosthesis: Single-Center Experience With 617 Implants. Ann Thorac Surg 2018; 105:40-46. [DOI: 10.1016/j.athoracsur.2017.05.080] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 11/22/2022]
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21
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Minakata K. Transcatheter aortic valve replacement: Suitable for all? J Cardiol 2017; 71:221-222. [PMID: 29195788 DOI: 10.1016/j.jjcc.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Kenji Minakata
- Division of Cardiovascular Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA.
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22
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Sud M, Tam DY, Wijeysundera HC. The Economics of Transcatheter Valve Interventions. Can J Cardiol 2017; 33:1091-1098. [DOI: 10.1016/j.cjca.2017.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 10/19/2022] Open
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23
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Tornos P, Ribera A. Una década de experiencia con el TAVI, el momento de resolver las dudas sobre su efectividad a largo plazo. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.09.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Tornos P, Ribera A. A Decade of Experience With Transcatheter Aortic Valve Replacement: Now Is the Time to Resolve Doubts About Long-term Effectiveness. ACTA ACUST UNITED AC 2017; 70:234-235. [PMID: 28109851 DOI: 10.1016/j.rec.2016.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Pilar Tornos
- Servicio de Cardiología, Hospital Vall d'Hebron y Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Aida Ribera
- Unidad de Epidemiología, Servicio de Cardiología, Hospital Vall d'Hebron y Vall d'Hebron Institut de Recerca (VHIR), CIBER de Epidemiología y Salud Pública, Barcelona, Spain
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25
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Abdelghani M, Serruys PW. Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis. Circ Cardiovasc Interv 2016; 9:e002944. [DOI: 10.1161/circinterventions.115.002944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/04/2016] [Indexed: 01/01/2023]
Abstract
Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients’ risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report.
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Affiliation(s)
- Mohammad Abdelghani
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Patrick W. Serruys
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
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26
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Ailawadi G, LaPar DJ, Speir AM, Ghanta RK, Yarboro LT, Crosby IK, Lim DS, Quader MA, Rich JB. Contemporary Costs Associated With Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2016; 101:154-60; discussion 160. [DOI: 10.1016/j.athoracsur.2015.05.120] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 05/16/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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