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Heathcote L, Srivastava T, Sarmah A, Kearns B, Sutton A, Candolfi P. A Systematic Review and Statistical Analysis of Factors Influencing the Cost-Effectiveness of Transcatheter Aortic Valve Implantation for Symptomatic Severe Aortic Stenosis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:459-475. [PMID: 37337594 PMCID: PMC10277006 DOI: 10.2147/ceor.s392566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/15/2023] [Indexed: 06/21/2023] Open
Abstract
Objective Transcatheter aortic valve implantation (TAVI) is a disruptive technology recommended for patients with symptomatic severe aortic stenosis (sSAS). Despite being available for over 15 years in Europe, with an extensive volume of clinical and economic evaluations across all surgical risk groups, there is little evidence on the identification of the key drivers of TAVI's cost-effectiveness. This study sought to identify these factors and quantify their role. Methods A systematic literature review was conducted to identify published economic evaluations of TAVI. This was supplemented by health technology assessment reports. The primary outcome was the likelihood of TAVI being found cost-effective. Secondary outcomes of TAVI being dominant, and the incremental health benefits of TAVI were also explored. Results Forty-two studies, reporting 65 unique analyses, were identified. TAVI was found to be cost-effective and dominant in 74% and 20% of analyses, respectively. The latest generation balloon-expandable TAVI device (SAPIEN 3) was more likely to be found cost-effective, as was TAVI use in low-risk populations and when performed via transfemoral access route. There was heterogeneity in the approach taken to economic modelling, which may also influence estimates of cost-effectiveness. Analyses that found TAVI to be dominant always compared it to surgery and usually considered the latest generation balloon-expandable TAVI device. Largest health benefits were observed for the inoperable risk group. Conclusion For patients with sSAS, TAVI is typically a cost-effective treatment option. There are important differences by device generation, risk group and access route. It is crucial to consider these differences when appraising the health economic evidence-base for TAVI.
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Affiliation(s)
- Laura Heathcote
- School for Health and Related Research, the University of Sheffield, Sheffield, UK
| | - Tushar Srivastava
- School for Health and Related Research, the University of Sheffield, Sheffield, UK
| | | | - Ben Kearns
- School for Health and Related Research, the University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School for Health and Related Research, the University of Sheffield, Sheffield, UK
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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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Permsuwan U, Yoodee V, Buddhari W, Wongpraparut N, Thonghong T, Cheewatanakornkul S, Meemook K, Sakiyalak P, Duangpakdee P, Yadee J. Cost-Utility Analysis of Transcatheter Aortic Valve Implantation versus Surgery in High-Risk Severe Aortic Stenosis Patients in Thailand. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:487-498. [PMID: 35909499 PMCID: PMC9331217 DOI: 10.2147/ceor.s371417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) has been shown to be effective in treating patients with severe symptomatic AS who are high-risk population for conventional surgical aortic valve replacement (SAVR). This study aimed to evaluate the cost–utility of TAVI compared with SAVR for severe aortic stenosis with high surgical risk in Thailand. Methods Lifetime costs and quality-adjusted life years (QALYs) from societal and healthcare perspectives were estimated using a two-part constructed model. The study population consisted of 80-year-old severe AS patients with high surgical risk. Mortality and complication rates were obtained from landmark trials. All cost–related and utility data were based on Thai population. Costs and QALYs were discounted at a rate of 3% annually and presented as 2021 values. Incremental cost-effectiveness ratios (ICERs) were computed. Sensitivity analyses were performed both deterministically and probabilistically. Results The findings from a societal perspective revealed that TAVI treatment was associated with higher cost (THB 1,551,895 [USD 47,371.64] vs THB 548,438 [USD 16,741.09] and higher QALYs than SAVR treatment (3.15 vs 2.31 QALYs). The estimated ICER was THB 1,196,191/QALY (USD 36,513.78 QALY). For the healthcare system perspective, TAVI treatment resulted in a higher total cost than SAVR treatment (THB 1,451,317 [USD 44,301.49] vs THB 432,398 [USD 13,198.95]) with comparable gains in LY and QALYs from a societal perspective. The ICER was calculated to be THB 1,214,624/QALY (USD 37,076.42/QALY). TAVI was not cost-effective at the Thai willingness to pay (WTP) threshold of THB 160,000/QALY (USD 4884/QALY). The model was the most sensitive to changes in TAVI valve cost and TAVI or SAVR treatment utilities. Conclusion TAVI is not a cost-effective strategy in patients with severe AS who are at high surgical risk when compared to SAVR at the WTP of THB 160,000/QALY (USD 4884/QALY) from the perspectives of society and the healthcare system.
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Affiliation(s)
- Unchalee Permsuwan
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Voratima Yoodee
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Pharmaceutical Care Training Center (PCTC), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Wacin Buddhari
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattawut Wongpraparut
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tasalak Thonghong
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirichai Cheewatanakornkul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Krissada Meemook
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pranya Sakiyalak
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsanae Duangpakdee
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jirawit Yadee
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Ryczek E, Peirce SC, Knight L, Cleves A, Champion A, Doull I, Lewis S. A Case Study on Reviewing Specialist Services Commissioning in Wales: TAVI for Severe Aortic Stenosis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:487-499. [PMID: 35211878 PMCID: PMC9206921 DOI: 10.1007/s40258-021-00692-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 06/14/2023]
Abstract
The Welsh Health Specialised Services Committee (WHSSC) is responsible for planning, commissioning and funding specialised healthcare in Wales. Investment in new technologies or services is based on clinical and economic evidence, using a consistent and transparent process. This is accomplished in three stages. The first stage is the preparation of a rapid evidence review. This then informs the development or update of the relevant Commissioning Policy. The final stage is to prioritise the Commissioning Policy recommendations against all other new services and interventions, to inform WHSSC's annual commissioning intentions. In 2017, a review was conducted of the WHSSC Commissioning Policy for transcatheter aortic valve implantation for severe aortic stenosis. Prior to this only high-risk patients were eligible for transcatheter aortic valve implantation. The rapid evidence review identified three randomised controlled trials and two economic analyses relevant to the decision problem. Transcatheter aortic valve implantation was generally found to be more expensive and more effective than medical management or surgical aortic valve replacement, with incremental cost-effectiveness ratios around £10,500-£36,000 for inoperable groups and £17,000-£24,000 in high-risk groups. The rapid evidence review, expert advice and stakeholder feedback informed the revision process of the Commissioning Policy for transcatheter aortic valve implantation. This recommended the addition of patients unsuitable for surgical aortic valve replacement and the removal of explicit risk scoring. This recommendation was subject to the prioritisation process (carried out annually). The updated transcatheter aortic valve implantation recommendation was ranked second out of 23 technologies and services competing for additional WHSSC funding. The WHSSC Integrated Commissioning Plan for specialised services in Wales (2019) therefore included funding to support the new criteria for transcatheter aortic valve implantation treatment.
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Affiliation(s)
| | - Susan C. Peirce
- Cedar, Cardiff Medicentre, Cardiff University, Heath Park, Cardiff, CF14 4UJ UK
| | - Laura Knight
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | - Andrew Cleves
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Iolo Doull
- Welsh Health Specialised Services Committee, Pontypridd, UK
| | - Sian Lewis
- Welsh Health Specialised Services Committee, Pontypridd, UK
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Gilard M, Eltchaninoff H, Iung B, Lefèvre T, Spaulding C, Dumonteil N, Mutuon P, Roussel C, Candolfi P, de Pouvourville G, Green M, Shore J. Cost-Effectiveness Analysis of SAPIEN 3 Transcatheter Aortic Valve Implantation Procedure Compared With Surgery in Patients With Severe Aortic Stenosis at Low Risk of Surgical Mortality in France. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:605-613. [PMID: 35365304 DOI: 10.1016/j.jval.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The clinical and cost-saving benefits of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis who are at high or intermediate risk of surgical mortality are supported by a growing evidence base. The PARTNER 3 trial (Placement of AoRTic TraNscathetER Valve Trial) demonstrated clinical benefits with SAPIEN 3 TAVI compared with SAVR in selected patients at low risk of surgical mortality. This study uses PARTNER 3 outcomes in combination with a French national hospital claim database to inform a cost-utility model and examine the cost implications of TAVI over SAVR in a low-risk population. METHODS A 2-stage cost-utility analysis was developed to estimate changes in both direct healthcare costs and health-related quality of life using TAVI with SAPIEN 3 compared with SAVR. Early adverse events associated with TAVI were captured using the PARTNER 3 data set. These data fed into a Markov model that captured longer-term outcomes of patients, after TAVI or SAVR intervention. RESULTS TAVI with SAPIEN 3 offers meaningful benefits over SAVR in providing both cost saving (€12 742 per patient) and generating greater quality-adjusted life-years (0.89 per patient). These results are robust with TAVI with SAPIEN 3 remaining dominant across several scenarios and deterministic and probabilistic sensitivity analyses. CONCLUSIONS This model demonstrated that TAVI with SAPIEN 3 was dominant compared with SAVR in the treatment of patients with severe symptomatic aortic stenosis who are at low risk of surgical mortality. These findings should help policy makers in developing informed approaches to intervention selection for this patient population.
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Affiliation(s)
- Martine Gilard
- Centre Hospitalier Régional et Universitaire de Brest, Brest, France.
| | - Hélène Eltchaninoff
- Department of Cardiology, CHU Rouen, UNIROUEN, Normandie Univ, Rouen, France
| | - Bernard Iung
- Hôpital Bichat Claude-Bernard (APHP), Paris, France
| | - Thierry Lefèvre
- Hôpital Privé Jacques Cartier, Ramsay-générale de santé, Massy, France
| | | | | | | | | | | | | | - Michelle Green
- York Health Economics Consortium, University of York, York, England, UK
| | - Judith Shore
- York Health Economics Consortium, University of York, York, England, UK
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7
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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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Mayhew CR, Gallagher A, Bensimhon A, Dauerman HL, Tsai MH, Martin JA. Cost-effectiveness analysis of a resource-intensive approach versus minimally invasive strategy for high-risk transcatheter aortic valve replacement patients. J Comp Eff Res 2022; 11:217-227. [PMID: 35142536 DOI: 10.2217/cer-2021-0210] [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: 11/21/2022] Open
Abstract
Aortic stenosis has a high mortality rate in patients who do not receive aortic valve replacement. Previously, transcatheter aortic valve replacement (TAVR) was an intervention reserved for individuals deemed high-risk for surgery. Since that time, TAVR has increasingly been offered to lower risk patients, yet it is unclear whether TAVR will meet an acceptable cost-effectiveness threshold in this group. In this cost-effectiveness study, we employed a decision tree model with Monte Carlo probability sensitivity analysis to determine the incremental cost (in US$) per quality-adjusted life year (QALY) and life year (LY) of performing the TAVR procedure using the resource-intensive approach versus the minimally invasive strategy in high-risk surgical patients.
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Affiliation(s)
- Christopher R Mayhew
- Department of Anesthesiology & Pain Medicine, University of Vermont Larner College of Medicine, Burlington, VT 05401, USA
| | - Andrew Gallagher
- Department of Anesthesiology & Pain Medicine, University of Vermont Larner College of Medicine, Burlington, VT 05401, USA
| | - Ariel Bensimhon
- Department of Anesthesiology & Pain Medicine, University of Vermont Larner College of Medicine, Burlington, VT 05401, USA
| | - Harold L Dauerman
- Division of Cardiovascular Medicine, University of Vermont Larner College of Medicine, Burlington, VT 05401, USA
| | - Mitchell H Tsai
- Department of Anesthesiology & Pain Medicine, University of Vermont Larner College of Medicine, Burlington, VT 05401, USA.,Department of Orthopaedics & Rehabilitation, University of Vermont Larner College of Medicine, Burlington, VT 05401, USA
| | - Jacob A Martin
- Department of Anesthesiology & Pain Medicine, University of Vermont Larner College of Medicine, Burlington, VT 05401, USA
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Geisler D, Rudziński PN, Hasan W, Andreas M, Hasimbegovic E, Adlbrecht C, Winkler B, Weiss G, Strouhal A, Delle-Karth G, Grabenwöger M, Mach M. Identifying Patients without a Survival Benefit following Transfemoral and Transapical Transcatheter Aortic Valve Replacement. J Clin Med 2021; 10:4911. [PMID: 34768430 PMCID: PMC8584860 DOI: 10.3390/jcm10214911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 01/01/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) offers a novel treatment option for patients with severe symptomatic aortic valve stenosis, particularly for patients who are unsuitable candidates for surgical intervention. However, high therapeutical costs, socio-economic considerations, and numerous comorbidities make it necessary to target and allocate available resources efficiently. In the present study, we aimed to identify risk factors associated with futile treatment following transfemoral (TF) and transapical (TA) TAVR. Five hundred and thirty-two consecutive patients (82 ± 9 years, female 63%) who underwent TAVR between June 2009 and December 2016 at the Vienna Heart Center Hietzing were retrospectively analyzed to identify predictors of futility, defined as all-cause mortality at one year following the procedure for the overall patient cohort, as well as the TF and TA cohort. Out of 532 patients, 91 (17%) did not survive the first year after TAVR. A multivariate logistic model identified cerebrovascular disease, home oxygen dependency, wheelchair dependency, periinterventional myocardial infarction, and postinterventional renal replacement therapy as the factors independently associated with an increased one-year mortality. Our findings underscore the significance of a precise preinterventional evaluation, as well as illustrating the subtle differences in baseline characteristics in the TF and TA cohort and their impact on one-year mortality.
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Affiliation(s)
- Daniela Geisler
- Department of Cardio-Vascular Surgery, Klinik Floridsdorf and Karl Landsteiner Institute for Cardio-Vascular Research, 1210 Vienna, Austria; (D.G.); (B.W.); (M.G.)
| | - Piotr Nikodem Rudziński
- Department of Coronary and Structural Heart Diseases, The Cardinal Stefan Wyszyński Institute of Cardiology, 04-628 Warsaw, Poland;
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (M.A.); (E.H.)
| | | | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (M.A.); (E.H.)
| | - Ena Hasimbegovic
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (M.A.); (E.H.)
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, 1090 Vienna, Austria
| | - Christopher Adlbrecht
- Imed19-Privat, Private Clinical Research Center, Chimanistrasse 1, 1190 Vienna, Austria;
| | - Bernhard Winkler
- Department of Cardio-Vascular Surgery, Klinik Floridsdorf and Karl Landsteiner Institute for Cardio-Vascular Research, 1210 Vienna, Austria; (D.G.); (B.W.); (M.G.)
| | - Gabriel Weiss
- Department of Vascular Surgery, Klinik Ottakring, 1160 Vienna, Austria;
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
| | - Andreas Strouhal
- Department of Cardiology, Klinik Floridsdorf and the Karl Landsteiner Institute for Cardiovascular & Intensive Care Research Vienna, 1210 Vienna, Austria; (A.S.); (G.D.-K.)
| | - Georg Delle-Karth
- Department of Cardiology, Klinik Floridsdorf and the Karl Landsteiner Institute for Cardiovascular & Intensive Care Research Vienna, 1210 Vienna, Austria; (A.S.); (G.D.-K.)
| | - Martin Grabenwöger
- Department of Cardio-Vascular Surgery, Klinik Floridsdorf and Karl Landsteiner Institute for Cardio-Vascular Research, 1210 Vienna, Austria; (D.G.); (B.W.); (M.G.)
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
| | - Markus Mach
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (M.A.); (E.H.)
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10
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Shah KK, Elder D, Nguyen MTH, Turner L, Doyle M, Woldendorp K, Seco M, Law CK, Wilson MK, Keech A, Ng MK, Morton RL. Transcatheter Aortic Valve Implantation (TAVI) Versus Surgical Aortic Valve Replacement for Aortic Stenosis (SAVR): A Cost-Comparison Study. Heart Lung Circ 2021; 30:1918-1928. [PMID: 34226106 DOI: 10.1016/j.hlc.2021.05.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/18/2021] [Accepted: 05/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Comparative costing studies using real-world data stratified by patient case-mix, are valuable to decision makers for making reimbursement decisions of new interventions. This study evaluated real-world hospital admissions and short-term costs of transcatheter aortic valve implantation (TAVI) and isolated surgical aortic valve replacement (SAVR) for patients with aortic stenosis, stratified by the Society of Thoracic Surgeons (STS) risk scores. METHODS Retrospective analysis of consecutive patients with a principal diagnosis of aortic stenosis who underwent isolated valve replacement at a single tertiary hospital, January 2012-December 2017. Patients were followed-up for 30 days post-procedure or until hospital discharge if index hospitalisation was greater than 30 days. Intensive care unit (ICU) and hospital length of stay (days), and costs in 2018 Australian dollars for the index procedure and 30-day follow-up were assessed. Multivariable generalised linear and two-part models with gamma distribution and log link function adjusting for Society of Thoracic Surgeons (STS) risk group and key sociodemographic characteristics were used. RESULTS Of 488 patients, 61% males, median age 78 years (IQR 14 years), 221 (45%) received transcatheter aortic valve replacement (TAVI) and 267 (55%) received surgical aortic valve replacement (SAVR). STS risk scores were low (28%), intermediate (46%) and high (26%) for TAVI patients, and low (85%), intermediate (12%) and high (3%) for SAVR patients. When adjusted, TAVI length of stay was 57% shorter than SAVR (95% CI 31-83%, p<0.001) for intensive care unit (ICU) admission, and 64% shorter (95% CI 47-81%, p<0.001) for hospital admissions. TAVI costs were 13% lower than SAVR (95% CI 4-22%, p=0.005). CONCLUSION This data suggests short-term health care costs are lower for patients with aortic stenosis undergoing TAVI than SAVR. A further roll-out of the TAVI program in hospitals across Australia may result in savings to the health system.
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Affiliation(s)
- Karan K Shah
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. https://twitter.com/karanshahk2
| | - Daniel Elder
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Mai T H Nguyen
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Lisa Turner
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Mathew Doyle
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kei Woldendorp
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael Seco
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Chi Kin Law
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Michael K Wilson
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Anthony Keech
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Martin K Ng
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rachael L Morton
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
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11
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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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12
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Azraai M, Gao L, Ajani AE. Cost-Effectiveness of Transcatheter Aortic Valve Intervention (TAVI) Compared to Surgical Aortic Valve Replacement (SAVR) in Low- to Intermediate-Surgical-Risk Patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1164-1168. [DOI: 10.1016/j.carrev.2020.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/05/2020] [Accepted: 01/09/2020] [Indexed: 12/01/2022]
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Sathananthan J, Ding L, Yu M, Catlin B, Chan A, Charania J, Cheung A, Cook R, Murdoch DJ, Della Siega A, Latham T, Lauck S, Polderman J, Robinson SD, Virani S, Wong D, Wood D, Ye J, Webb JG. Implications of Transcatheter Heart Valve Selection on Early and Late Pacemaker Rate and on Length of Stay. Can J Cardiol 2019; 34:1165-1173. [PMID: 30170672 DOI: 10.1016/j.cjca.2018.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/24/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) can cause injury to the atrioventricular conduction system. We evaluated the effect of transcatheter heart valve (THV) type on the rate of new pacemaker implantation and length of hospital stay. METHODS Patients across all hospitals performing transfemoral TAVR in the province of British Columbia between 2012 and 2016 participated in a mandated registry with linkages to provincial health databases. We evaluated 1141 patients undergoing successful transfemoral TAVR for native aortic valve stenosis with 5 commonly used valves. RESULTS Valves implanted were balloon-expandable (BEV) (n = 728), self-expandable (SEV) (n = 341), and mechanically-expandable (MEV) (n = 72). Baseline clinical characteristics were similar between groups: mean age 82.5 years with multiple comorbidities. The mean Society of Thoracic Surgeons predicted risk of mortality was 6.0%. Indwelling temporary pacemakers after TAVR varied by THV type: (BEV) 4.0%, (SEV) 69.3%, and (MEV) 63.0% (P < 0.002). The need for a new permanent pacemaker varied by THV type: (BEV) 6.6%, (SEV) 24.0%, and (MEV) 32.8% at 30 days (P < 0.001). At 1 year, permanent pacemaker rates continued to rise, and remained divergent: (BEV) 8.9%, (SEV) 26.9%, and (MEV) 35.9% (P < 0.001). Median length of stay varied according to THV type: (BEV) 1, (SEV) 3, and (MEV) 4 days (P < 0.001 across groups). Crude mortality rates were not statistically different by THV type, either at 30 days (BEV 3.0%, SEV 2.9%, and MEV 0.0%; P = 0.33), or at 1 year (BEV 10.3%, SEV 15.0%, and MEV 8.3%; P = 0.11). CONCLUSIONS The choice of a THV device was associated with significant differences in the need for post-TAVR temporary pacemakers, hospital length of stay, and both early and late pacemaker implantation rates. These differences may have an impact on patient morbidity and resource utilization.
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Affiliation(s)
| | - Lillian Ding
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Maggie Yu
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Bonnie Catlin
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Albert Chan
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | - Anson Cheung
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - Richard Cook
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Dale J Murdoch
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | | | - Tim Latham
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - Jopie Polderman
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | | | - Sean Virani
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Daniel Wong
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - David Wood
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada.
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Thom H, Visan AC, Keeney E, Dorobantu DM, Fudulu D, T A Sharabiani M, Round J, Stoica SC. Clinical and cost-effectiveness of the Ross procedure versus conventional aortic valve replacement in young adults. Open Heart 2019; 6:e001047. [PMID: 31275578 PMCID: PMC6546187 DOI: 10.1136/openhrt-2019-001047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/08/2019] [Accepted: 04/14/2019] [Indexed: 01/27/2023] Open
Abstract
Objectives In young and middle-aged adults, there are three current options for aortic valve replacement (AVR), namely mechanical AVR (mechAVR), tissue AVR (biological AVR) and the Ross operation, with no clear guidance on the best option. We aim to compare the clinical effectiveness and cost-effectiveness of the Ross procedure with conventional AVR in young and middle-aged adults. Methods This is a systematic literature review and meta-analysis of AVR options. Markov multistate model was adopted to compare cost-effectiveness. Lifetime costs, quality-adjusted life years (QALYs), net monetary benefit (NMB), population expected value of perfect information (EVPI) and expected value of partial perfect information were estimated. Results We identified 48 cohorts with a total number of 12 975 patients (mean age 44.5 years, mean follow-up 7.1 years). Mortality, bleeding and thromboembolic events over the follow-up period were lowest after the Ross operation, compared with mechAVR and biological AVR (p<0.001). Aortic reoperation rates were lower after Ross compared with biological AVR, but slightly higher when compared with mechAVR (p<0.001). At a willingness-to-pay threshold of £20effective. At a willingness-to-pay threshold of £20, 000 per QALY000 per QALY, the Ross procedure is more cost-effective compared the Ross procedure is more cost-effective compared withwith conventional AVR, with a lifetime incremental NMB of £60 conventional AVR, with a lifetime incremental NMB of £60 952 (952 (££3030 236236 to to ££7979 464). Incremental costs were £12464). Incremental costs were £12 323 (323 (££61086108 to to ££1515 972) and incremental QALYs 3.66 (1.81972) and incremental QALYs 3.66 (1.81 to to 4.76). The population EVPI indicates that a trial costing up to £2.03 million could be cost 4.76). The population EVPI indicates that a trial costing up to £2.03 million could be cost--effective. At a willingness-to-pay threshold of £20 000 per QALY, the Ross procedure is more cost-effective compared with conventional AVR, with a lifetime incremental NMB of £60 952 (£30 236 to £79 464). Incremental costs were £12 323 (£6108 to £15 972) and incremental QALYs 3.66 (1.81 to 4.76). The population EVPI indicates that a trial costing up to £2.03 million could be cost-effective. Conclusions In young and middle-aged adults with aortic valve disease, the Ross procedure may confer greater quality of life and be more cost-effective than conventional AVR. A high-quality randomised trial could be warranted and cost-effective.
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Affiliation(s)
- Howard Thom
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Alexandru Ciprian Visan
- Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK.,Department of Cardiothoracic Surgery, University Hospital Southampton, Southampton, UK
| | - Edna Keeney
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Dan Mihai Dorobantu
- Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK.,Cardiology, Institutul de Urgenta pentru Boli Cardiovasculare Prof Dr C C Iliescu, Bucuresti, Romania
| | - Daniel Fudulu
- Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta, Canada
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Saadi M, Tagliari AP, Danzmann LC, Bartholomay E, Kochi AN, Saadi EK. Update in Heart Rhythm Abnormalities and Indications for Pacemaker After Transcatheter Aortic Valve Implantation. Braz J Cardiovasc Surg 2019; 33:286-290. [PMID: 30043922 PMCID: PMC6089127 DOI: 10.21470/1678-9741-2017-0206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022] Open
Abstract
Objective: Rhythm abnormalities following transcatheter aortic valve implantation
(TAVI) and indications for permanent pacemaker implantation (PPI) were reviewed,
which aren't well established in the current guidelines. New left bundle branch
block and atrioventricular block are the most common electrocardiographic
changes after TAVI. PPI incidence ranges from 9-42% for self-expandable and
2.5-11.5% for balloon expandable devices. Not only anatomical variations in
conduction system have an important role in conduction disorders, but different
valve characteristics and their relationship with cardiac structures as well.
Previous right bundle branch block has been confirmed as one of the most
significant predictors for PPI.
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Affiliation(s)
- Marina Saadi
- Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
| | - Ana Paula Tagliari
- Department of Cardiovascular Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Luiz Cláudio Danzmann
- Department of Cardiology, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
| | - Eduardo Bartholomay
- Department of Cardiology, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
| | - Adriano Nunes Kochi
- Department of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Eduardo Keller Saadi
- Department of Cardiovascular Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Povero M, Miceli A, Pradelli L, Ferrarini M, Pinciroli M, Glauber M. Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:733-745. [PMID: 30510436 PMCID: PMC6231515 DOI: 10.2147/ceor.s185743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Meta-analyses of studies comparing transcatheter aortic valve implants (TAVIs) and sutureless aortic valve replacement (SU-AVR) show differing effectiveness and safety profiles. The approaches also differ in their surgical cost (including operating room and device). OBJECTIVE The objective of this study was to assess the incremental cost-utility of SU-AVR vs TAVIs for the treatment of intermediate- to high-risk patients in the US, Germany, France, Italy, UK, and Australia. METHODS A patient-level simulation compares in-hospital pathways of patients undergoing SU-AVR or TAVIs; later, patient history is modeled at the cohort level. Hospital outcomes for TAVIs reproduce data from recent series; in SU-AVR patients, outcomes are obtained by applying relative efficacy estimates in a recent meta-analysis on 1,462 patients. After discharge, survival depends on the development of paravalvular leak and the need for dialysis. A comprehensive third-party payer perspective encompassing both in-hospital and long-term costs was adopted. RESULTS Due to lower in-hospital (4.1% vs 7.0%) and overall mortality, patients treated with SU-AVR are expected to live an average of 1.25 years more compared with those undergoing TAVIs, with a mean gain of 1.14 quality-adjusted life-years. Both in-hospital and long-term costs were lower for SU-AVR than for TAVIs with total savings ranging from $4,158 (France) to $20,930 (US). CONCLUSION SU-AVR results dominant when compared to TAVIs in intermediate- to high-risk patients. Both in-hospital and long-term costs are lower for SU-AVR than for TAVI patients, with concomitant significant gains in life expectancy, both raw and adjusted for the quality of life.
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Affiliation(s)
| | - Antonio Miceli
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Matteo Ferrarini
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | | | - Mattia Glauber
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
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Veličković VM, Borisenko O, Svensson M, Spelman T, Siebert U. Congenital heart defect repair with ADAPT tissue engineered pericardium scaffold: An early-stage health economic model. PLoS One 2018; 13:e0204643. [PMID: 30261033 PMCID: PMC6160133 DOI: 10.1371/journal.pone.0204643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 09/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the cost effectiveness of tissue engineered bovine tissue pericardium scaffold (CardioCel) for the repair of congenital heart defects in comparison with surgery using xenogeneic, autologous, and synthetic patches over a 40-year time horizon from the perspective of the UK National Health Service. METHODS A six-state Markov state-transition model to model natural history of disease and difference in the interventional effect of surgeries depending on patch type implanted. Patches differed regarding their probability of re-operation due to patch calcification, based on a systematic literature review. Transition probabilities were based on the published literature, other clinical inputs were based on UK registry data, and cost data were based on UK sources and the published literature. Incremental cost-effectiveness ratio (ICER) was determined as incremental costs per quality adjusted life years (QALY) gained. We used a 40-year analytic time-horizon and adopted the payer perspective. Comprehensive sensitivity analyses were performed. RESULTS According to the model predictions, CardioCel was associated with reduced incidence of re-operation, increased QALY, and costs savings compared to all other patches. Cost savings were greatest compared to synthetic patches. Estimated cost savings associated with CardioCel were greatest within atrioventricular septal defect repair and lowest for ventricular septal defect repair. Based on our model, CardioCel relative risk for re-operations is 0.938, 0.956and 0.902 relative to xenogeneic, autologous, and synthetic patches, respectively. CONCLUSION CardioCel was estimated to increase health benefits and save cost when used during surgery for congenital heart defects instead of other patches.
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Affiliation(s)
- Vladica M. Veličković
- Synergus AB, Health Economics and Evidence Synthesis Department, Stockholm, Sweden
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Reseaech and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Oleg Borisenko
- Synergus AB, Health Economics and Evidence Synthesis Department, Stockholm, Sweden
| | - Mikael Svensson
- Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tim Spelman
- Synergus AB, Health Economics and Evidence Synthesis Department, Stockholm, Sweden
- Centre for Population Health, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Reseaech and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Huygens SA, Takkenberg JJM, Rutten-van Mölken MPMH. Systematic review of model-based economic evaluations of heart valve implantations. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:241-255. [PMID: 28265822 PMCID: PMC5813051 DOI: 10.1007/s10198-017-0880-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 02/16/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To review the evidence on the cost-effectiveness of heart valve implantations generated by decision analytic models and to assess their methodological quality. METHODS A systematic review was performed including model-based cost-effectiveness analyses of heart valve implantations. Study and model characteristics and cost-effectiveness results were extracted and the methodological quality was assessed using the Philips checklist. RESULTS Fourteen decision-analytic models regarding the cost-effectiveness of heart valve implantations were identified. In most studies transcatheter aortic valve implantation (TAVI) was cost-effective compared to standard treatment (ST) in inoperable or high-risk operable patients (ICER range 18,421-120,779 €) and in all studies surgical aortic valve replacement (SAVR) was cost-effective compared to ST in operable patients (ICER range 14,108-40,944 €), but the results were not consistent on the cost-effectiveness of TAVI versus SAVR in high-risk operable patients (ICER range: dominant to dominated by SAVR). Mechanical mitral valve replacement (MVR) had the lowest costs per success compared to mitral valve repair and biological MVR. The methodological quality of the studies was moderate to good. CONCLUSION This review showed that improvements can be made in the description and justification of methods and data sources, sensitivity analysis on extrapolation of results, subgroup analyses, consideration of methodological and structural uncertainty, and consistency (i.e. validity) of the models. There are several opportunities for future decision-analytic models of the cost-effectiveness of heart valve implantations: considering heart valve implantations in other valve positions besides the aortic valve, using a societal perspective, and developing patient-simulation models to investigate the impact of patient characteristics on outcomes.
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Affiliation(s)
- Simone A Huygens
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Health Policy and Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Bayle Building, Campus Woudestein, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maureen P M H Rutten-van Mölken
- Department of Health Policy and Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Bayle Building, Campus Woudestein, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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Kaier K, Reinecke H, Naci H, Frankenstein L, Bode M, Vach W, Hehn P, Zirlik A, Zehender M, Reinöhl J. The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:223-228. [PMID: 28229254 DOI: 10.1007/s10198-017-0877-7] [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: 07/09/2016] [Accepted: 02/07/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND The impact of various post-procedural complications after transcatheter aortic valve implantation (TAVI) on resource use and their consequences in the German reimbursement system has still not been properly quantified. METHODS In a retrospective observational study, we use data from the German DRG statistic on patient characteristics and in-hospital outcomes of all isolated TAVI procedures in 2013 (N = 9147). The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation was analyzed using both unadjusted and risk-adjusted linear and logistic regression analyses. RESULTS A total of 235 (2.57%) strokes, 583 (6.37%) bleeding events, 474 (5.18%) cases of acute kidney injury and 1428 (15.61%) pacemaker implantations were documented. The predicted reimbursement of an uncomplicated TAVI procedure was €33,272, and bleeding events were associated with highest additional reimbursement (€12,839, p < 0.001), extra length of stay (14.58 days, p < 0.001), and increased likelihood of mechanical ventilation for more than 48 h (OR 17.91, p < 0.001). A more moderate complication-related impact on resource use and reimbursement was found for acute kidney injury (additional reimbursement: €5963, p < 0.001; extra length of stay: 7.92 days, p < 0.001; ventilation >48 h: OR 6.93, p < 0.001) as well as for stroke (additional reimbursement: €4125, p < 0.001; extra length of stay: 4.68 days, p < 0.001; ventilation >48 h: OR 5.73, p < 0.001). Pacemaker implantations, in contrast, were associated with comparably small increases in reimbursement (€662, p = 0.006) and length of stay (3.54 days, p = 0.006) and no impaired likelihood of mechanical ventilation more than 48 h (OR 1.22, p = 0.156). Interestingly, these complication-related consequences remain mostly unchanged after baseline risk-adjustment. CONCLUSIONS Post procedural complications such as bleeding events, acute kidney injuries and strokes are associated with increased resource use and substantial amounts of additional reimbursement in Germany, which has important implications for decision making outside of the usual clinical sphere.
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Affiliation(s)
- Klaus Kaier
- Center for Medical Biometry and Medical Informatics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany.
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany.
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Huseyin Naci
- LSE Health, Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Martin Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
- Faculty of Business Management and Social Sciences, Osnabrück University of Applied Sciences, Osnabrück, Germany
| | - Werner Vach
- Center for Medical Biometry and Medical Informatics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Philip Hehn
- Center for Medical Biometry and Medical Informatics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Andreas Zirlik
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
| | - Jochen Reinöhl
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
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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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Mokhles MM, Huygens SA, Takkenberg JJM. The Risk in Avoiding Risk: Optimizing Decision Making in Structural Heart Disease Interventions. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1407466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mostafa M. Mokhles
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simone A. Huygens
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johanna J. M. Takkenberg
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Banovic MD, Nikolic SD. Treatment Strategies in Symptomatic Intermediate, Low-Risk, and Asymptomatic Patients With Severe Aortic Stenosis. Curr Probl Cardiol 2017; 43:335-354. [PMID: 29290389 DOI: 10.1016/j.cpcardiol.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Survival of symptomatic patients with severe aortic stenosis (AS) is very poor, with an average mortality reaching up to 2% per month. Approach to diagnosis and treatment of patients with AS was conservative; patients were referred to surgery only if the AS-induced symptoms become apparent and significantly limit the quality of patient' life. In the past 15 years, the novel treatment strategy in subgroups of symptomatic patients with AS have been the subject of extensive research, starting from introduction of transcatheter aortic valve implant (TAVI) in inoperable symptomatic patients with severe AS and continuing further to patients with very high and high operative risk. In the past few years, the focus has further shifted toward the patients with lower operative risk, as well as to asymptomatic patients with severe AS. In the former group, the question relates to whether TAVI is beneficial when compared to SAVR in intermediate- to low-risk patients with symptomatic AS. In the latter group, the main issue is if and when the SAVR should be performed. This article analyzes current status and evidences regarding treatment strategies in symptomatic high, intermediate, low-risk, and asymptomatic patients with isolated severe AS.
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23
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Geisler BP, Huygens SA, Reardon MJ, Van Mieghem N, Kappetein AP, Osnabrugge RLJ, Pietzsch JB. Cost-Effectiveness and Projected Survival of Self-Expanding Transcatheter Versus Surgical Aortic Valve Replacement for High Risk Patients in a European Setting: A Dutch Analysis Based on the CoreValve High Risk Trial. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1381357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Benjamin P. Geisler
- Wing Tech Inc., Irvine, California, USA
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Abstract
The use of transcatheter aortic valve implantation (TAVI) to treat severe symptomatic aortic valve stenosis has increased exponentially in the last decade. This rapid expansion was seen predominantly in Western developed nations and has been fuelled by favorable results reported from a plethora of well-publicized randomized controlled trials, large retrospective series and national registries. Now, TAVI has become the standard of care for inoperable patients and an alternative to open surgery in patients who are at intermediate to high risk for open surgery. Notwithstanding these positive results, Asia has been relatively slow to adopt this technology despite a potentially large patient pool. Unique features of Asian medical environments and differences in Asian anatomy affecting TAVI uptake in Asia will be discussed. This article serves to outline the various challenging aspects of disseminating TAVI in Asian countries.
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Affiliation(s)
- Jimmy Kim Fatt Hon
- National University Heart Centre, National University of Singapore, Singapore
| | - Edgar Tay
- National University Heart Centre, National University of Singapore, Singapore
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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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Abstract
Transcatheter aortic valve implantation (TAVI), an established treatment for inoperable and high-risk operable symptomatic patients with severe aortic stenosis with growing numbers of procedures and expanding indications, is an expensive therapy. Cost-effectiveness analyses rely on the value of the incremental cost-effectiveness ratio (ICER), which is the difference in cost between two possible interventions, divided by the difference in their effect. Several analyses have demonstrated that TAVI is cost-effective with an acceptable ICER for the inoperable patient alone and only via the iliofemoral route, while TAVI is more costly and is either less or equally effective as surgery in high-risk operable patients. When use of TAVI is extended to include a larger number of patients suitable for surgery, the overall results become less favorable. Acceptable ICERs should practically equate to the value of the gross domestic product (GDP) per capita in each country; however, the cost of the TAVI kit alone already exceeds the GDP per capita of all moderate- and low-income countries. An overview of the current cost-efficacy issues of TAVI is presented and this grisly reality is discussed, which may hopefully be improved in the future.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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Kaier K, von Kampen F, Baumbach H, von Zur Mühlen C, Hehn P, Vach W, Zehender M, Bode C, Reinöhl J. Two-year post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement in Germany. BMC Health Serv Res 2017; 17:473. [PMID: 28693565 PMCID: PMC5504607 DOI: 10.1186/s12913-017-2432-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/04/2017] [Indexed: 11/17/2022] Open
Abstract
Background This study presents data on post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement over a two year period. Methods Based 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. Results At 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. Conclusions Substantial 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 registration German Clinical Trial Register Nr. DRKS00000797. Electronic supplementary material The 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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Affiliation(s)
- Klaus Kaier
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg im Breisgau, Germany. .,Department of Cardiology, Heart Center Freiburg University, Freiburg im Breisgau, Germany. .,Clinical Epidemiology, Center for Medical Biometry and Medical Informatics, Medical Center - University of Freiburg, Stefan-Meier-Str. 26, D-79104, Freiburg, Germany.
| | - Frederike von Kampen
- Department of Cardiology, Heart Center Freiburg University, Freiburg im Breisgau, Germany
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | | | - Philip Hehn
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Werner Vach
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Manfred Zehender
- Department of Cardiology, Heart Center Freiburg University, Freiburg im Breisgau, Germany
| | - Christoph Bode
- Department of Cardiology, Heart Center Freiburg University, Freiburg im Breisgau, Germany
| | - Jochen Reinöhl
- Department of Cardiology, Heart Center Freiburg University, Freiburg im Breisgau, Germany
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Tarricone R, Callea G, Ogorevc M, Prevolnik Rupel V. Improving the Methods for the Economic Evaluation of Medical Devices. HEALTH ECONOMICS 2017; 26 Suppl 1:70-92. [PMID: 28139085 DOI: 10.1002/hec.3471] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 10/30/2016] [Accepted: 11/23/2016] [Indexed: 05/12/2023]
Abstract
Medical devices (MDs) have distinctive features, such as incremental innovation, dynamic pricing, the learning curve and organisational impact, that need to be considered when they are evaluated. This paper investigates how MDs have been assessed in practice, in order to identify methodological gaps that need to be addressed to improve the decision-making process for their adoption. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist supplemented by some additional categories to assess the quality of reporting and consideration of the distinctive features of MDs. Two case studies were considered: transcatheter aortic valve implantation (TAVI) representing an emerging technology and implantable cardioverter defibrillators (ICDs) representing a mature technology. Economic evaluation studies published as journal articles or within Health Technology Assessment reports were identified through a systematic literature review. A total of 19 studies on TAVI and 41 studies on ICDs were analysed. Learning curve was considered in only 16% of studies on TAVI. Incremental innovation was more frequently mentioned in the studies of ICDs, but its impact was considered in only 34% of the cases. Dynamic pricing was the most recognised feature but was empirically tested in less than half of studies of TAVI and only 32% of studies on ICDs. Finally, organisational impact was considered in only one study of ICDs and in almost all studies on TAVI, but none of them estimated its impact. By their very nature, most of the distinctive features of MDs cannot be fully assessed at market entry. However, their potential impact could be modelled, based on the experience with previous MDs, in order to make a preliminary recommendation. Then, well-designed post-market studies could help in reducing uncertainties and make policymakers more confident to achieve conclusive recommendations. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Rosanna Tarricone
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Giuditta Callea
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Marko Ogorevc
- Institute for Economic Research, Ljubljana, Slovenia
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Barbanti M, Gulino S, Costa G, Tamburino C. Pathophysiology, incidence and predictors of conduction disturbances during Transcatheter Aortic Valve Implantation. Expert Rev Med Devices 2017; 14:135-147. [PMID: 28092726 DOI: 10.1080/17434440.2017.1282819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Over the past decade, transcatheter aortic valve implantation (TAVI) has evolved rapidly toward an extremely reproducible, safe and effective procedure, with a marked reduction of its related complications. However, the occurrence of conduction disturbances and the need for permanent pacemaker implantation (PPI) after TAVI remains a concern. Areas covered: In this article review, we will go through the mechanisms involved in conduction disturbances after TAVI, and we will discuss the key aspects of pathophysiology, incidence and predictors of conduction disturbances following Transcatheter Aortic Valve Implantation. The evaluation of patient's valve anatomy and the selection of the most appropriate prosthesis have been proposed as a valuable options to reduce the incidence of conductions disturbances. Moreover, in recent times, a great number of new TAVI devices, so-called 'second-generation devices', have been introduced to address the limitations of the first-generation devices, including conduction disturbance, with scarce results. Expert commentary: Conduction disturbances after TAVI are increasingly recognized as an important issue in TAVI complications. Further characterization of the procedural- and patient-related factors that contribute to the development of conduction abnormalities will help to improve prosthesis designs and patient selection, making TAVI even more safer.
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Affiliation(s)
- Marco Barbanti
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Simona Gulino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Giuliano Costa
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Corrado Tamburino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
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Huygens SA, Rutten-van Mölken MPMH, Bekkers JA, Bogers AJJC, Bouten CVC, Chamuleau SAJ, de Jaegere PPT, Kappetein AP, Kluin J, van Mieghem NMDA, Versteegh MIM, Witsenburg M, Takkenberg JJM. Conceptual model for early health technology assessment of current and novel heart valve interventions. Open Heart 2016; 3:e000500. [PMID: 27843569 PMCID: PMC5073474 DOI: 10.1136/openhrt-2016-000500] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/02/2016] [Indexed: 01/02/2023] Open
Abstract
Objective The future promises many technological advances in the field of heart valve interventions, like tissue-engineered heart valves (TEHV). Prior to introduction in clinical practice, it is essential to perform early health technology assessment. We aim to develop a conceptual model (CM) that can be used to investigate the performance and costs requirements for TEHV to become cost-effective. Methods After scoping the decision problem, a workgroup developed the draft CM based on clinical guidelines. This model was compared with existing models for cost-effectiveness of heart valve interventions, identified by systematic literature search. Next, it was discussed with a Delphi panel of cardiothoracic surgeons, cardiologists and a biomedical scientist (n=10). Results The CM starts with the valve implantation. If patients survive the intervention, they can remain alive without complications, die from non-valve-related causes or experience a valve-related event. The events are separated in early and late events. After surviving an event, patients can experience another event or die due to non-valve-related causes. Predictors will include age, gender, NYHA class, left ventricular function and diabetes. Costs and quality adjusted life years are to be attached to health conditions to estimate long-term costs and health outcomes. Conclusions We developed a CM that will serve as foundation of a decision-analytic model that can estimate the potential cost-effectiveness of TEHV in early development stages. This supports developers in deciding about further development of TEHV and identifies promising interventions that may result in faster take-up in clinical practice by clinicians and reimbursement by payers.
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Affiliation(s)
- Simone A Huygens
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands; Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands; Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Jos A Bekkers
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering , Eindhoven University of Technology , Eindhoven , The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology , University Medical Centre , Utrecht , The Netherlands
| | - Peter P T de Jaegere
- Department of Cardiology , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery , Academic Medical Centre , Amsterdam , The Netherlands
| | | | - Michel I M Versteegh
- Department of Cardio-Thoracic Surgery , Leiden University Medical Centre , Leiden , The Netherlands
| | - Maarten Witsenburg
- Department of Cardiology , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
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Wijeysundera HC, Li L, Braga V, Pazhaniappan N, Pardhan AM, Lian D, Leeksma A, Peterson B, Cohen EA, Forsey A, Kingsbury KJ. Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation. Open Heart 2016; 3:e000468. [PMID: 27621832 PMCID: PMC5013496 DOI: 10.1136/openhrt-2016-000468] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/25/2016] [Accepted: 07/24/2016] [Indexed: 01/20/2023] Open
Abstract
Objective Transcatheter aortic valve implantation (TAVI) is generally more expensive than surgical aortic valve replacement (SAVR) due to the high cost of the device. Our objective was to understand the patient and procedural drivers of cumulative healthcare costs during the index hospitalisation for these procedures. Design All patients undergoing TAVI, isolated SAVR or combined SAVR+coronary artery bypass grafting (CABG) at 7 hospitals in Ontario, Canada were identified during the fiscal year 2012–2013. Data were obtained from a prospective registry. Cumulative healthcare costs during the episode of care were determined using microcosting. To identify drivers of healthcare costs, multivariable hierarchical generalised linear models with a logarithmic link and γ distribution were developed for TAVI, SAVR and SAVR+CABG separately. Results Our cohort consisted of 1310 patients with aortic stenosis, of whom 585 underwent isolated SAVR, 518 had SAVR+CABG and 207 underwent TAVI. The median costs for the index hospitalisation for isolated SAVR were $21 811 (IQR $18 148–$30 498), while those for SAVR+CABG were $27 256 (IQR $21 741–$39 000), compared with $42 742 (IQR $37 295–$56 196) for TAVI. For SAVR, the major patient-level drivers of costs were age >75 years, renal dysfunction and active endocarditis. For TAVI, chronic lung disease was a major patient-level driver. Procedural drivers of cost for TAVI included a non-transfemoral approach. A prolonged intensive care unit stay was associated with increased costs for all procedures. Conclusions We found wide variation in healthcare costs for SAVR compared with TAVI, with different patient-level drivers as well as potentially modifiable procedural factors. These highlight areas of further study to optimise healthcare delivery.
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Affiliation(s)
- Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Ontario, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lindsay Li
- Cardiac Care Network , Toronto, Ontario , Canada
| | - Vevien Braga
- Cardiac Care Network , Toronto, Ontario , Canada
| | - Nandhaa Pazhaniappan
- Division of Cardiology , Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto , Ontario, Ontario , Canada
| | | | - Dana Lian
- Cardiac Care Network , Toronto, Ontario , Canada
| | - Aric Leeksma
- Cardiac Care Network , Toronto, Ontario , Canada
| | - Ben Peterson
- Royal Victoria Regional Health Centre , Barrie, Ontario , Canada
| | - Eric A Cohen
- Division of Cardiology , Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto , Ontario, Ontario , Canada
| | - Anne Forsey
- Cardiac Care Network , Toronto, Ontario , Canada
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HEALTH TECHNOLOGY ASSESSMENTS REPORTING COST-EFFECTIVENESS OF TRANSCATHETER AORTIC VALVE IMPLANTATION. Int J Technol Assess Health Care 2016; 32:89-96. [DOI: 10.1017/s0266462316000180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: Made available since 2002, transcatheter aortic valve implantation (TAVI) is a minimally invasive new intervention which can provide significant survival improvement to patients with aortic stenosis. However, TAVI is expensive and currently not reimbursed by many governments. Some governments and institutions have been conducting health technology assessments (HTAs) to inform their reimbursement decisions. The aim of the present study is to review HTAs that have relied on a cost-effectiveness analysis to inform reimbursement decisions of TAVI.Methods: A systematic literature review was conducted among published literature as well as reports released by HTA agencies. Predetermined inclusion and exclusion criteria, following the Preferred Reporting System for Systematic Reviews and Meta-Analysis guidelines, were used to select relevant HTAs. The selected papers were assessed against the Consolidated Health Economic Evaluation Reporting Standards.Results: HTAs on TAVI from three countries were available for this review: Canada, Belgium, and the United Kingdom. All three HTAs used the Placement of Aortic Transcatheter Valve (PARTNER) trial data with Markov models to estimate the incremental cost effectiveness ratio. The three HTAs recommended conditional reimbursement for TAVI for otherwise inoperable patients. The HTAs did not use clear methods to estimate the health-related utility which ultimately affected their cost-effectiveness results. The UK HTA showed the best value for money (US$20,416 per quality-adjusted life-year).Conclusion: All studies found TAVI to be more costly and less effective for high-risk patients suitable for surgery, whereas TAVI was consistently found to be cost effective for otherwise inoperable patients.
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Kaier K, Gutmann A, Baumbach H, von Zur Mühlen C, Hehn P, Vach W, Beyersdorf F, Zehender M, Bode C, Reinöhl J. Quality of life among elderly patients undergoing transcatheter or surgical aortic valve replacement- a model-based longitudinal data analysis. Health Qual Life Outcomes 2016; 14:109. [PMID: 27456092 PMCID: PMC4960709 DOI: 10.1186/s12955-016-0512-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 07/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Quality of life (QoL) measurements reported in observational studies are often biased, since patients who failed to improve are more likely to be unable to respond due to death or impairment. In order to observe the development of QoL in patients close to death, we analyzed a set of monthly QoL measurements for a cohort of elderly patients treated for aortic valve stenosis (AS) with special consideration of the effect of distance to death. Methods QoL in 169 elderly patients (age ≥ 75 years), treated either with transcatheter aortic valve replacement (TAVR; n = 92), surgical aortic-valve replacement (n = 70), or drug-based therapy (n = 7), was evaluated using the standardized EQ-5D questionnaire. Over a two-year period, patients were consulted using monthly telephone interviews or outpatient visits, leading to a total of 2463 time points at which QoL values, New York Heart Association (NYHA) Functional Classification and their status of assistance were assessed. Furthermore, post-procedural clinical events and complications were monitored. Linear and ordered logistic regression analyses with random intercept were carried out, taking into account overall trends and distance to death. Results QoL measures decreased slightly over time, were temporarily impaired at month 1 after the initial episode of hospitalization and decreased substantially at the end of life with a measurable effect starting at the sixth from last follow-up (month) before death. Many clinical complications (bleeding complications, stroke, acute kidney injury) showed an impairment of QoL measurements, but the inclusion of lagged variables demonstrated medium term (three months) QoL impairments for access site bleeding only. All other complications are associated with event-related impairments that decreased dramatically at the second and third follow-up interviews (month) after event. Conclusions Distance to death shows clear effects on QoL and should be taken into account when analyzing QoL measures in the elderly patients treated for aortic valve stenosis. Trial registration German Clinical Trial Register Nr. DRKS00000797
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, D-79104, Freiburg, Germany. .,Department of Cardiology, Heart Center Freiburg University, Freiburg, Germany.
| | - Anja Gutmann
- Department of Cardiology, Heart Center Freiburg University, Freiburg, Germany
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | | | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, D-79104, Freiburg, Germany
| | - Werner Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, D-79104, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology, Heart Center Freiburg University, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology, Heart Center Freiburg University, Freiburg, Germany
| | - Jochen Reinöhl
- Department of Cardiology, Heart Center Freiburg University, Freiburg, Germany
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Freeman PM, Protty MB, Aldalati O, Lacey A, King W, Anderson RA, Smith D. Severe symptomatic aortic stenosis: medical therapy and transcatheter aortic valve implantation (TAVI)-a real-world retrospective cohort analysis of outcomes and cost-effectiveness using national data. Open Heart 2016; 3:e000414. [PMID: 27335656 PMCID: PMC4908912 DOI: 10.1136/openhrt-2016-000414] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/06/2016] [Accepted: 05/03/2016] [Indexed: 01/07/2023] Open
Abstract
Objectives Determine the real-world difference between 2 groups of patients with severe aortic stenosis and similar baseline comorbidities: surgical turn down (STD) patients, who were managed medically prior to the availability of transcatheter aortic valve implantation (TAVI) following formal surgical outpatient assessment, and patients managed with a TAVI implant. Design Retrospective cohort study from real-world data. Setting Electronic patient letters were searched for patients with a diagnosis of severe aortic stenosis and a formal outpatient STD prior to the availability of TAVI (1999–2009). The second group comprised the first 90 cases of TAVI in South Wales (2009 onwards). 2 years prior to and 5 years following TAVI/STD were assessed. Patient data were pseudoanonymised, using the Secure Anonymized Information Linkage (SAIL) databank, and extracted from Office National Statistics (ONS), Patient-Episode Database for Wales (PEDW) and general practitioner databases. Population 90 patients who had undergone TAVI in South Wales, and 65 STD patients who were medically managed. Main outcome measures Survival, hospital admission frequency and length of stay, primary care visits, and cost-effectiveness. Results TAVI patients were significantly older (81.8 vs 79.2), more likely to be male (59.1% vs 49.3%), baseline comorbidities were balanced. Mortality in TAVI versus STD was 28% vs 70% at 1000 days follow-up. There were significantly more hospital admissions per year in the TAVI group prior to TAVI/STD (1.5 (IQR 1.0–2.4) vs 1.0 IQR (0.5–1.5)). Post TAVI/STD, the TAVI group had significantly lower hospital admissions (0.3 (IQR 0.0–1.0) vs 1.2 (IQR 0.7–3.0)) and lengths of stay (0.4 (IQR 0.0–13.8) vs 11.0 (IQR 2.5–28.5), p<0.05). The incremental cost-effectiveness ratio (ICER) for TAVI was £10 533 per quality-adjusted life year (QALY). Conclusions TAVI patients were more likely to survive and avoid hospital admissions compared with the medically managed STD group. The ICER for TAVI was £10 533 per QALY, making it a cost-effective procedure.
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Affiliation(s)
- Phillip M Freeman
- Division of Population Medicine, Cardiff University, Cardiff, UK; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Majd B Protty
- Division of Population Medicine , Cardiff University , Cardiff , UK
| | | | | | - William King
- Division of Population Medicine , Cardiff University , Cardiff , UK
| | | | - Dave Smith
- Morriston Hospital, Swansea, UK; Swansea University, Swansea, UK
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Ruparelia N, Prendergast BD. Transcatheter aortic valve implantation - what the general physician needs to know. Clin Med (Lond) 2015; 15:420-5. [PMID: 26430178 PMCID: PMC4953224 DOI: 10.7861/clinmedicine.15-5-420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With an increasingly elderly population, the incidence of aortic stenosis (AS) is rising. While surgical aortic valve replacement remains the gold standard treatment for patients with severe symptomatic AS, transcatheter aortic valve implantation (TAVI) has emerged as the treatment of choice for patients who are inoperable or high surgical risk. TAVI has been shown to be associated with a clear mortality benefit when compared with medical therapy and to be at least as good as surgical aortic valve replacement in this patient group. The last few years have seen rapid development in this revolutionary technology in conjunction with increasing centre and operator experience, and indications for the procedure are swiftly expanding. In this review, we summarise the current evidence base and discuss factors that need to be considered by the general physician when contemplating TAVI as a treatment option, including practical aspects, emerging indications and future directions.
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Affiliation(s)
- Neil Ruparelia
- Hammersmith Hospital, Imperial College, London, UK, and Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
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36
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Mangieri A, Regazzoli D, Ruparelia N, Colombo A, Latib A. Recent advances in transcatheter aortic valve replacement for high-risk patients. Expert Rev Cardiovasc Ther 2015; 13:1237-49. [PMID: 26414888 DOI: 10.1586/14779072.2015.1093935] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic stenosis is the most common valvular heart disease of old age. Patients with severe aortic stenosis who develop symptoms have a very poor prognosis without valve intervention. Surgical aortic valve replacement has historically been the only treatment option for these patients. However a significant minority are considered inoperable or at high surgical risk and therefore are refused or decline surgery. In recent years, transcatheter aortic valve replacement has emerged as an alternative treatment option in these high-risk patients. The aim of this review is to summarize the current role of transcatheter aortic valve replacement in contemporary clinical practice including recent advances in technological and procedural aspects and then discuss future directions.
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Affiliation(s)
- Antonio Mangieri
- a 1 Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Damiano Regazzoli
- a 1 Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Neil Ruparelia
- a 1 Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy.,b 2 Imperial College, London, UK.,c 3 Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Antonio Colombo
- a 1 Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy.,c 3 Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- a 1 Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy.,c 3 Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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Affiliation(s)
- Neil Ruparelia
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK Hammersmith Hospital, London, UK
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Iannaccone A, Marwick TH. Cost effectiveness of transcatheter aortic valve replacement compared with medical management or surgery for patients with aortic stenosis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:29-45. [PMID: 25488391 DOI: 10.1007/s40258-014-0141-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND In the symptomatic patient, severe aortic stenosis (AS) has an extremely adverse prognosis in the absence of valve replacement, inevitably leading to deterioration of heart function, heart failure, and death. However, many patients with severe AS, advanced age, and comorbid disease may die with AS rather than from AS. While the results of surgical aortic valve replacement (SAVR) are extremely favorable, this technique is not always possible because of either local- or patient-level contraindications. Over the last decade, transcatheter aortic valve replacement (TAVR) has emerged as a new treatment strategy for selected patients with AS. It has now become the standard of care for extremely high-risk (inoperable) patients with AS, and is an appropriate alternative to surgery in high-risk but operable patients. However, whether this intervention is a cost-effective use of resources is open to question AIM The aim of this review was to assess the results and quality of the economic evaluations in the current literature and to identify the drivers of cost effectiveness. METHODS We performed an electronic data search using four different electronic databases, selecting all studies that included cost-effectiveness data for TAVR compared with either medical management or surgery. Sixteen studies were evaluated for a qualitative and quantitative assessment. RESULTS The quality of the cost-effectiveness analyses (CEAs) were generally sufficient. In contrast, we found an extreme heterogeneity of input assumptions with consequent difficulties to generalize the conclusions. However, in the population of patients with severe symptomatic AS and a prohibitive surgical risk, TAVR generally represents a good choice, with incremental costs that are well balanced by the great benefit in terms of quality of life and survival. Nevertheless, the cost effectiveness of this procedure in the real world, particularly in patients with high healthcare costs from other comorbid conditions, may be less favorable. In AS patients with high (but not prohibitive) surgical risk, the choice between TAVR and SAVR is still debatable. Both procedures are comparable in terms of efficacy and safety but the evidence is inconclusive from an economic point of view. CONCLUSIONS 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.
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Affiliation(s)
- Andrea Iannaccone
- Menzies Research Institute Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
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Analysis of the additional costs of clinical complications in patients undergoing transcatheter aortic valve replacement in the German Health Care System. Int J Cardiol 2015; 179:231-7. [DOI: 10.1016/j.ijcard.2014.11.095] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/08/2014] [Indexed: 11/19/2022]
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Brecker S, Mealing S, Padhiar A, Eaton J, Sculpher M, Busca R, Bosmans J, Gerckens UJ, Wenaweser P, Tamburino C, Bleiziffer S, Piazza N, Moat N, Linke A. Cost-utility of transcatheter aortic valve implantation for inoperable patients with severe aortic stenosis treated by medical management: a UK cost-utility analysis based on patient-level data from the ADVANCE study. Open Heart 2014; 1:e000155. [PMID: 25349700 PMCID: PMC4207938 DOI: 10.1136/openhrt-2014-000155] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/18/2014] [Accepted: 09/01/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To use patient-level data from the ADVANCE study to evaluate the cost-effectiveness of transcatheter aortic valve implantation (TAVI) compared to medical management (MM) in patients with severe aortic stenosis from the perspective of the UK NHS. METHODS A published decision-analytic model was adapted to include information on TAVI from the ADVANCE study. Patient-level data informed the choice as well as the form of mathematical functions that were used to model all-cause mortality, health-related quality of life and hospitalisations. TAVI-related resource use protocols were based on the ADVANCE study. MM was modelled on publicly available information from the PARTNER-B study. The outcome measures were incremental cost-effectiveness ratios (ICERs) estimated at a range of time horizons with benefits expressed as quality-adjusted life-years (QALY). Extensive sensitivity/subgroup analyses were undertaken to explore the impact of uncertainty in key clinical areas. RESULTS Using a 5-year time horizon, the ICER for the comparison of all ADVANCE to all PARTNER-B patients was £13 943 per QALY gained. For the subset of ADVANCE patients classified as high risk (Logistic EuroSCORE >20%) the ICER was £17 718 per QALY gained). The ICER was below £30 000 per QALY gained in all sensitivity analyses relating to choice of MM data source and alternative modelling approaches for key parameters. When the time horizon was extended to 10 years, all ICERs generated in all analyses were below £20 000 per QALY gained. CONCLUSION TAVI is highly likely to be a cost-effective treatment for patients with severe aortic stenosis.
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Affiliation(s)
| | | | | | | | | | - Rachele Busca
- Medtronic International Trading Sàrl , Tolochenaz , Switzerland
| | | | | | | | | | | | - Nicolo Piazza
- McGill University Health Center, Royal Victoria Hospital , Montreal , Canada
| | - Neil Moat
- Royal Brompton Hospital , London , UK
| | - Axel Linke
- University Hospital Leipzig , Leipzig , Germany
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D'Onofrio A, Salizzoni S, Agrifoglio M, Lucchetti V, Musumeci F, Esposito G, Magagna P, Aiello M, Savini C, Cassese M, Glauber M, Punta G, Alfieri O, Gabbieri D, Mangino D, Agostinelli A, Livi U, Di Gregorio O, Minati A, Faggian G, Filippini C, Rinaldi M, Gerosa G. When does transapical aortic valve replacement become a futile procedure? An analysis from a national registry. J Thorac Cardiovasc Surg 2014; 148:973-9; discussion 979-80. [DOI: 10.1016/j.jtcvs.2014.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 11/26/2022]
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Clinical significance of conduction disturbances after aortic valve intervention: current evidence. Clin Res Cardiol 2014; 104:1-12. [DOI: 10.1007/s00392-014-0739-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/24/2014] [Indexed: 12/16/2022]
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Awad W, Mathur A, Baldock L, Oliver S, Kennon S. Comparing post-operative resource consumption following transcatheter aortic valve implantation (TAVI) and conventional aortic valve replacement in the UK. J Med Econ 2014; 17:357-64. [PMID: 24621135 DOI: 10.3111/13696998.2014.904322] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To define the in-hospital and 6-month post-discharge resource use, following Transcatheter Aortic Valve Implantation (TAVI) and conventional Aortic Valve Replacement (AVR) surgery within a single UK hospital. METHODS A local service evaluation of patients undergoing TAVI or AVR between January 2011 and May 2012 captured data until 6-months post-procedure, collected from hospital records and via a General Practitioner questionnaire. The main end-points were mortality, time in ITU/HDU, hospital length of stay (LoS), discharge destination, re-admission, and post-discharge primary/secondary care resource use. Sub-group analyses were performed for AVR patients aged ≥80 (AVR ≥ 80) and with EuroSCORE of ≥10 (AVR ES ≥ 10) to allow more direct comparison with 'TAVI type' patients. RESULTS Results are given as means (standard deviation) for TAVI (n = 51), AVR (n = 188), AVR ≥ 80 (n = 48), and AVR ES ≥ 10 (n = 47), respectively, unless otherwise stated. Age in years was 83.0 (8.1), 71.2 (13.1), 84.1 (2.7), 79.4 (7.1); EuroSCORE was 24.7 (11.9), 8.1 (6.4), 12.0 (6.0), and 16.5 (6.6); post-operative LoS (days) was 11.5 (11.2), 10.9 (10.8), 14.3 (16.7), and 15.2 (17.7). For discharged patients, 0%, 7%, 13%, and 9% had unplanned cardiac-related re-admissions within 30-days of discharge. Time to first readmission was 74.6 (34.0), 35.0 (34.2), 20.8 (9.7), and 22.6 (14.3) days. LIMITATIONS This was a single-center retrospective evaluation, not prospectively powered to confirm differences in outcomes. CONCLUSIONS Despite TAVI being performed in an older, higher risk population, LoS was similar to AVR. Most strikingly there were no cardiac-related re-admissions within 30-days for TAVI and time to first re-admission was significantly longer. This evaluation suggests that TAVI is clinically appropriate and provides economic advantages in both the hospital and post-discharge setting in this high risk group. Many patients undergoing TAVI are considered unfit for surgery and, hence, TAVI offers a treatment that delivers similar results to traditional AVR without the high risk associated with surgery.
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Affiliation(s)
- W Awad
- London Chest Hospital , London , UK
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Staab W, Bergau L, Lotz J, Sohns C. Prevalence of noncardiac findings in computed tomography angiography before transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2014; 8:222-9. [DOI: 10.1016/j.jcct.2014.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/09/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
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Garnier F, Eicher JC, Jazayeri S, Bertaux G, Bouchot O, Aho LS, Wolf JE, Laurent G. Usefulness and limitations of contractile reserve evaluation in patients with low-flow, low-gradient aortic stenosis eligible for cardiac resynchronization therapy. Eur J Heart Fail 2014; 16:648-54. [DOI: 10.1002/ejhf.78] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/03/2014] [Accepted: 02/07/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Fabien Garnier
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
| | - Jean-Christophe Eicher
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
| | - Saed Jazayeri
- Department of Cardiovascular Surgery; University Hospital; Dijon France
| | - Géraldine Bertaux
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
| | - Olivier Bouchot
- Department of Cardiovascular Surgery; University Hospital; Dijon France
- Laboratoire LE2I UMR CNRS 5158; Université de Bourgogne; Dijon France
| | - Ludwig-Serge Aho
- Department of Hygiene and Epidemiology; University Hospital; Dijon France
| | - Jean-Eric Wolf
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
- Laboratoire LE2I UMR CNRS 5158; Université de Bourgogne; Dijon France
| | - Gabriel Laurent
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
- Laboratoire LE2I UMR CNRS 5158; Université de Bourgogne; Dijon France
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