ClinicoEconomics and Outcomes Research (Nov 2018)

Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk

  • Povero M,
  • Miceli A,
  • Pradelli L,
  • Ferrarini M,
  • Pinciroli M,
  • Glauber M

Journal volume & issue
Vol. Volume 10
pp. 733 – 745

Abstract

Read online

Massimiliano Povero,1 Antonio Miceli,2,3 Lorenzo Pradelli,1 Matteo Ferrarini,2 Matteo Pinciroli,4 Mattia Glauber2 1AdRes Health Economics and Outcomes Research, Turin, Italy; 2Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant’Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy; 3Bristol Heart Institute, University of Bristol, Bristol, UK; 4LivaNova, Milan, Italy 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. Keywords: sutureless valve, aortic valve replacement, TAVI, DES model, cost-utility 

Keywords