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Cost effectiveness of transcatheter aortic valve replacement compared to medical management in inoperable patients with severe aortic stenosis: Canadian analysis based on the PARTNER Trial Cohort B findings.
- Source :
-
Journal of medical economics [J Med Econ] 2013; Vol. 16 (4), pp. 566-74. Date of Electronic Publication: 2013 Feb 06. - Publication Year :
- 2013
-
Abstract
- Objective: The only effective treatment for severe aortic stenosis (AS) is valve replacement. However, many patients with co-existing conditions are ineligible for surgical valve replacement, historically leaving medical management (MM) as the only option which has a poor prognosis. Transcatheter Aortic Valve Replacement (TAVR) is a less invasive replacement method. The objective was to estimate cost-effectiveness of TAVR via transfemoral access vs MM in surgically inoperable patients with severe AS from the Canadian public healthcare system perspective.<br />Methods: A cost-effectiveness analysis of TAVR vs MM was conducted using a deterministic decision analytic model over a 3-year time horizon. The PARTNER randomized controlled trial results were used to estimate survival, utilities, and some resource utilization. Costs included the valve replacement procedure, complications, hospitalization, outpatient visits/tests, and home/nursing care. Resources were valued (2009 Canadian dollars) using costs from the Ontario Case Costing Initiative (OCCI), Ontario Ministry of Health and Long-Term Care and Ontario Drug Benefits Formulary, or were estimated using relative costs from a French economic evaluation or clinical experts. Costs and outcomes were discounted 5% annually. The effect of uncertainty in model parameters was explored in deterministic and probabilistic sensitivity analysis.<br />Results: The incremental cost-effectiveness ratio (ICER) was $32,170 per quality-adjusted life year (QALY) gained for TAVR vs MM. When the time horizon was shortened to 24 and 12 months, the ICER increased to $52,848 and $157,429, respectively. All other sensitivity analysis returned an ICER of less than $50,000/QALY gained.<br />Limitations: A limitation was lack of availability of Canadian-specific resource and cost data for all resources, leaving one to rely on clinical experts and data from France to inform certain parameters.<br />Conclusions: Based on the results of this analysis, it can be concluded that TAVR is cost-effective compared to MM for the treatment of severe AS in surgically inoperable patients.
- Subjects :
- Canada
Cost-Benefit Analysis
Heart Valve Prosthesis Implantation methods
Hospitalization economics
Humans
Models, Economic
Patient Acuity
Postoperative Complications economics
Quality-Adjusted Life Years
Survival Analysis
Aortic Valve Stenosis surgery
Health Services economics
Health Services statistics & numerical data
Heart Valve Prosthesis Implantation economics
Subjects
Details
- Language :
- English
- ISSN :
- 1941-837X
- Volume :
- 16
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of medical economics
- Publication Type :
- Academic Journal
- Accession number :
- 23356420
- Full Text :
- https://doi.org/10.3111/13696998.2013.770747