1
|
Carapinha JL, Al-Omar HA, Alqoofi F, Samargandy SA, Candolfi P. Budget impact analysis of transcatheter aortic valve replacement in low, intermediate, and high-risk patients with severe aortic stenosis in Saudi Arabia. J Med Econ 2022; 25:77-86. [PMID: 34927509 DOI: 10.1080/13696998.2021.2020569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIMS A budget impact analysis (BIA) comparing transcatheter aortic valve replacement (TAVR) with SAPIEN 3 and surgical aortic valve replacement (SAVR) for severe, symptomatic aortic stenosis among patients of low, intermediate, and high surgical risk from the perspective of the public and private sectors in Saudi Arabia. MATERIALS AND METHODS A Markov model was developed with six states to calculate the budget impact from time of either TAVR or SAVR intervention up to 5 years. We compared the budget effects of new permanent pacemaker implantation (PPI), new onset atrial fibrillation (AF), major/disabling stroke (MDS), and surgical site infections (SSI). One-way sensitivity analyses (OWSA) were performed on cost and probability inputs. RESULTS Analysis of the base case parameters suggests TAVR vs. SAVR is budget saving among intermediate- and high-risk patients at 5 years. TAVR vs. SAVR for low surgical risk reaches budget neutrality at 5 years. TAVR is associated with higher costs for PPI and budget savings for MDS, AF, and SSI. TAVR also results in savings for non-device costs due to fewer human resource uses and shorter procedure durations. Similarly, TAVR is associated with cost savings due to shorter hospital intensive care unit (ICU) and non-ICU stays. The OWSA consistently revealed that SAVR non-device theater costs were the leading cost driver across all surgical risk levels. LIMITATIONS This is the first budget impact analysis of its kind in Saudi Arabia and future research is needed on costing TAVR and SAVR procedures, the economic impact of SSI, and corroborating estimates for the public and private sectors. CONCLUSIONS Payers, providers, and policymakers increasingly turn to results of BIA to inform technologies affordability decisions. TAVR with SAPIEN 3 appears to generate savings vs. SAVR from a budget impact perspective across various surgical risk levels in Saudi Arabia.
Collapse
Affiliation(s)
- João L Carapinha
- Affiliate Assistant Professor of Pharmacy, Northeastern University School of Pharmacy, Boston, MA, USA
- Director, Syenza, Anaheim, CA, USA
| | - Hussain A Al-Omar
- Pharmacoeconomics and Pharmaceutical Policy, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Director for Health Technology Assessment Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Faisal Alqoofi
- Interventional Cardiologist, John Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Sondos A Samargandy
- Interventional Cardiologist, Interventional Cardiology Division, Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Pascal Candolfi
- THV Market Access, Edwards Lifesciences Crop., Nyon, Switzerland
| |
Collapse
|
2
|
Schymik G, Wendler O, Hengstenberg C, Ohlmann P, Gilard M, Digne F, Souteyrand G, Letocart V, van Belle E, Bramlage P, Tarantini G. Outcomes of transfemoral balloon expandable transcatheter aortic valve implantation: Comparison of two subsequent valve generations. Catheter Cardiovasc Interv 2020; 96:930-939. [PMID: 31794159 DOI: 10.1002/ccd.28621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND The SAPIEN 3 (S3) addresses several limitations of the SAPIEN XT (SXT) for the performance of transfemoral (TF-) balloon expandable transcatheter aortic valve implantation (TAVI). OBJECTIVES We aimed to determine whether their altered features translate into improved outcomes in a real-world TF-TAVI patient population. METHODS Data for 3,314 patients were extracted from the European registries SOURCE-XT and SOURCE-3. Patients were propensity-score (PS) matched (n = 1,169/group). RESULTS In the PS matched comparison, device success was higher in the S3 (99.2%) compared to the SXT group (98.2%; p = .04). S3 patients experienced a lower rate of procedural death (0.7 vs. 2.6%; p = .0004), moderate/severe paravalvular leakage (PVL; 1.4 vs. 5.5%; p < .0001), and procedure-related stroke (1.2 vs. 2.4%; p = .04) while higher rates of mean aortic valve gradients ≥20 mmHg, and new permanent pacemaker implantations were seen. At 30 days a lower rate of all-cause mortality was seen (2.1% vs. 4.3%; p = .003), which was preserved after 1 year (10.7% vs. 14.9%; p = .002). A Cox regression predicting 1-year mortality resulted in a hazard ratio of 0.684 in favor of S3 (p = .0026). The same was true of stroke (2.8% vs. 5.7%; p = .0007), and moderate/severe PVL (2.7 vs. 7.3%; p = .0002) at 1 year. The rate of new pacemaker implantations (13.6% vs. 9.5%; p = .001) and NYHA III/IV (12.8 vs. 8.6%; p = .004) was higher with the S3. CONCLUSIONS The improved features of the S3 appear to translate into improved survival and reduced rates of adverse complications, with the exception of a higher rate of new pacemaker implantations.
Collapse
Affiliation(s)
| | | | - Christian Hengstenberg
- Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Vienna, Austria
| | | | | | - Franck Digne
- Centre Cardiologique du Nord, Saint-Denis, France
| | | | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | | |
Collapse
|
3
|
Isogai T, Saad AM, Ahuja KR, Shekhar S, Abdelfattah OM, Gad MM, Svensson LG, Krishnaswamy A, Kapadia SR. Short‐term outcomes of transcatheter aortic valve replacement for pure native aortic regurgitation in the United States. Catheter Cardiovasc Interv 2020; 97:477-485. [DOI: 10.1002/ccd.29189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/17/2020] [Accepted: 07/19/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio USA
| | - Anas M. Saad
- Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio USA
| | - Keerat R. Ahuja
- Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio USA
| | - Omar M. Abdelfattah
- Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio USA
| | - Mohamed M. Gad
- Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio USA
| | - Lars G. Svensson
- Department of Thoracic and Cardiovascular Surgery Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio USA
| |
Collapse
|
4
|
Health-related quality of life following transcatheter aortic valve implantation using transaortic, transfemoral approaches and surgical aortic valve replacement-a single-center study. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:657-665. [PMID: 30534139 PMCID: PMC6283815 DOI: 10.11909/j.issn.1671-5411.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To evaluate short- and long-term changes in quality of life (QoL) in patients undergoing transcatheter aortic valve implantation (TAVI) and to assess differences in patient QoL when using the TAVI transaortic (TAVI TAo) approach compared with the transfemoral approach (TAVI TF) and surgical aortic valve replacement (SAVR). Methods Ninety-seven patients were assessed. Thirty-two patients underwent TAVI TAo, 31 underwent TAVI TF and 34 patients underwent SAVR. QoL was assessed using the EQ-5D-3L questionnaire at baseline, after one month and one year. Results Mean patient age was 80 years (range, 61–92 years) and the mean logistic EuroSCORE was 12.45% (range, 1.39%–78.98%). Declared health state at baseline was significantly lower in TAVI TF (P < 0.001) and after one month there were no differences between the three groups (P = 0.99). After one year, SAVR patient results of the EQ-5D-3L index value were lower in comparison to both TAVI patient groups (P < 0.05). The analysis also showed significant differences between the results of EQ-5D-3L index value over the one month and one year follow-up (TAVI TAo, P < 0.001; TAVI TF, P < 0.05; SAVR, P < 0.05). In all groups, the values significantly increased after one-month and one-year of follow-up in comparison to baseline value. Significant differences were also demonstrated between Visual Analogue Scale values (VAS). Conclusions A significant improvement in QoL was observed in all three patient groups. Regardless of the TAVI approach, EQ-5D-3L and VAS values were significantly increased after one-month and one-year follow up; the SAVR patients however, reported lower health status when compared to the TAVI patients.
Collapse
|
5
|
del Val D, Ferreira-Neto AN, Asmarats L, Maes F, Guimaraes L, Junquera L, Wintzer J, Fischer Q, Barroso de Freitas Ferraz A, Puri R, Rodés-Cabau J. Transcatheter aortic valve replacement: relative safety and efficacy of the procedure with different devices. Expert Rev Med Devices 2018; 16:11-24. [DOI: 10.1080/17434440.2019.1552132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Frédéric Maes
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Jérome Wintzer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Quentin Fischer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Rishi Puri
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| |
Collapse
|
6
|
Cocchieri R, Petzina R, Romano M, Jagielak D, Bonaros N, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Rein KA, Verhoye JP, Gerosa G, Bapat V, Baumbach H, Sims H, Deutsch C, Bramlage P, Kurucova J, Thoenes M, Frank D. Outcomes after transaortic transcatheter aortic valve implantation: long-term findings from the European ROUTE†. Eur J Cardiothorac Surg 2018; 55:737-743. [DOI: 10.1093/ejcts/ezy333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/30/2018] [Accepted: 09/06/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Riccardo Cocchieri
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Rainer Petzina
- Department of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Kiel, Germany
| | - Mauro Romano
- Department of Thoracic and Cardiovascular Surgery, Institut Hospitalier Jacques Cartier, Massy, France
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S. Matteo, Pavia University School of Medicine, Pavia, Italy
| | - Joel Lapeze
- Department of Cardiovascular Surgery, Hospital Louis Pradel, Lyon, France
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Sidney Chocron
- Department of Cardiac Surgery, Hospital Jean Minjoz, University Hospital of Besancon, Besancon, France
| | - Douglas Muir
- Department of Cardiothoracic Surgery, James Cook Hospital, Middlesbrough, UK
| | - Walter Eichinger
- Department of Cardiothoracic Surgery, Klinikum Bogenhausen, Munich, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, Essen, Germany
| | - Louis Labrousse
- Department of Cardiovascular Surgery, CHU Hospital of Bordeaux, Bordeaux, France
| | - Kjell Arne Rein
- Department of Cardiothoracic Surgery, Rikshospital Oslo, Oslo, Norway
| | | | - Gino Gerosa
- Department of Cardiac Surgery, University of Padova, Padova, Italy
| | - Vinayak Bapat
- Department of Cardiac Surgery, St. Thomas‘Hospital, London, UK
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany
| | - Helen Sims
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Jana Kurucova
- Edwards Lifesciences, Medical Affairs/Professional Education, Nyon, Switzerland
| | - Martin Thoenes
- Edwards Lifesciences, Medical Affairs/Professional Education, Nyon, Switzerland
| | - Derk Frank
- Department of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Kiel, Germany
| |
Collapse
|