Transcatheter aortic valve implantation against conventional aortic valve replacement surgery in high-risk patients with aortic stenosis; a cost-effectiveness analysis

Health Economics Review

Research

Meysam Mortazian¹  Shiva Khaleghparast²  Naser Kachoueian³  Hesam Ghiasvand⁴  Farhad Gorjipour⁵  Seyran Naghdi⁶  Kourosh Tirgarfakheri⁷  Yaser Toloueitabar⁷ 

[1] AJA University of Medical Sciences Tehran Iran AJA University of Medical Sciences, Tehran, Iran;Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran;Department of Cardiac Surgery, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran;Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK;Iranian Scientific Society of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran;National Center for Health Insurance Research, Tehran, Iran;Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran;

关键词: Aortic stenosis;    Transcatheter Aortic Valve Implantation (TAVI);    Surgical Aortic Valve Replacement;    Cost-effectiveness analysis;    Economic evaluation;   

DOI  :  10.1186/s13561-022-00411-w

 received in 2022-05-05, accepted in 2022-12-01,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundAortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in financial resources, it is crucial to investigate the cost-effectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-effectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery.MethodsThis study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran’s national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty.ResultsThe incremental cost, effectiveness, and cost-effectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$ 1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-effective at one and three times the country’s Gross Domestic Production (GDP) is 0.31 and 0.83, respectively.ConclusionsTAVI does not seem a cost-effective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-effective will raise to 83%.

【 授权许可】

CC BY   
© The Author(s) 2022. corrected publication 2023

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