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Early cost-utility analysis of tissue-engineered heart valves compared to bioprostheses in the aortic position in elderly patients
- Source :
- European journal of health economics : HEPAC, 21(4), 557-572. Springer Verlag, European Journal of Health Economics, 21(4), 557-572. Springer, The European Journal Of Health Economics, 21(4), 557-572. Springer-Verlag, The European Journal of Health Economics
- Publication Year :
- 2020
- Publisher :
- Springer-Verlag, 2020.
-
Abstract
- Objectives Aortic valve disease is the most frequent indication for heart valve replacement with the highest prevalence in elderly. Tissue-engineered heart valves (TEHV) are foreseen to have important advantages over currently used bioprosthetic heart valve substitutes, most importantly reducing valve degeneration with subsequent reduction of re-intervention. We performed early Health Technology Assessment of hypothetical TEHV in elderly patients (≥ 70 years) requiring surgical (SAVR) or transcatheter aortic valve implantation (TAVI) to assess the potential of TEHV and to inform future development decisions. Methods Using a patient-level simulation model, the potential cost-effectiveness of TEHV compared with bioprostheses was predicted from a societal perspective. Anticipated, but currently hypothetical improvements in performance of TEHV, divided in durability, thrombogenicity, and infection resistance, were explored in scenario analyses to estimate quality-adjusted life-year (QALY) gain, cost reduction, headroom, and budget impact. Results Durability of TEHV had the highest impact on QALY gain and costs, followed by infection resistance. Improved TEHV performance (− 50% prosthetic valve-related events) resulted in lifetime QALY gains of 0.131 and 0.043, lifetime cost reductions of €639 and €368, translating to headrooms of €3255 and €2498 per hypothetical TEHV compared to SAVR and TAVI, respectively. National savings in the first decade after implementation varied between €2.8 and €11.2 million (SAVR) and €3.2–€12.8 million (TAVI) for TEHV substitution rates of 25–100%. Conclusions Despite the relatively short life expectancy of elderly patients undergoing SAVR/TAVI, hypothetical TEHV are predicted to be cost-effective compared to bioprostheses, commercially viable and result in national cost savings when biomedical engineers succeed in realising improved durability and/or infection resistance of TEHV.
- Subjects :
- Male
medicine.medical_specialty
Technology Assessment, Biomedical
Transcatheter aortic
Cost-Benefit Analysis
Economics, Econometrics and Finance (miscellaneous)
030204 cardiovascular system & hematology
SDG 3 – Goede gezondheid en welzijn
03 medical and health sciences
0302 clinical medicine
Infection resistance
SDG 3 - Good Health and Well-being
Internal medicine
Humans
Medicine
Patient-level simulation model
030212 general & internal medicine
Heart valve replacement
Heart valve
Aged
Aged, 80 and over
Bioprosthesis
Heart Valve Prosthesis Implantation
Original Paper
Cost–utility analysis
Tissue engineered
I18
Tissue Engineering
business.industry
Health Policy
Tissue-engineered heart valves
Early health technology assessment
I19
Short life
Quality-adjusted life year
medicine.anatomical_structure
Heart valve implantation
Heart Valve Prosthesis
Cardiology
Female
Quality-Adjusted Life Years
Health Expenditures
business
Models, Econometric
Subjects
Details
- Language :
- English
- ISSN :
- 14396637, 14393972, and 16187598
- Volume :
- 21
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- European Journal of Health Economics
- Accession number :
- edsair.doi.dedup.....b392d0eaeadba52ff57b135c8cf88262