Prior economic analyses had shown that transcatheter aortic valve replacement (TAVR) is cost-effective (which does not mean that it saves money) in high-risk patients compared with surgical replacement. In intermediate-risk patients, this equation was mere speculation until this work recently published in Circulation came along.
Physicians started wondering about costs and durability after PARTNER 2 showed similar rates of death and stroke for both strategies.
Between 2011 and 2014, 3110 intermediate-risk patients with severe aortic stenosis were randomized to TAVR or surgery.
Among them, 2032 patients were randomized to receive TAVR using the Sapien XT valve or surgery in the PARTNER 2A trial, while 1078 additional patients were included in the PARTNER S3i registry using the newest-generation of the aforementioned balloon-expandable valve, which offers a lower delivery profile and sealing skirt designed to reduce paravalvular regurgitation.
Read also: Revascularization in Patients with Multivessel Disease, Diabetes, and Kidney Disease.
Different calculation methods were used to estimate costs and generalization proved difficult, since costs may differ among countries or regions due to the local currency to USD exchange rate, intermediaries, etc. In this work, procedural costs were globally higher with TAVR than surgery. However, cost differences for the index hospitalization were relatively small with the use of the XT device, and TAVR was cheaper than surgery with the use of the newer-generation device (p < 0.001), mainly due to shorter hospital stays.
As the follow-up period went by, TAVR costs were increasingly lower (and the quality of life also improved).
Conclusion
In intermediate-risk patients, TAVR is projected to be more economically convenient than surgery from the perspective of the United States healthcare system, providing both greater quality-adjusted life expectancy and lower costs. However, this may not remain true for all contexts and economies, particularly in Latin America.
Original title: Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis at Intermediate Risk. Results from the PARTNER 2 Trial.
Reference: Suzanne J. Baron et al. Circulation. 2019;139:877-888.
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