Author/Authors :
Reynolds، نويسنده , , Matthew R. and Magnuson، نويسنده , , Elizabeth A. and Lei، نويسنده , , Yang and Wang، نويسنده , , Kaijun and Vilain، نويسنده , , Katherine and Li، نويسنده , , Haiyan and Walczak، نويسنده , , Joshua and Pinto، نويسنده , , Duane S. and Thourani، نويسنده , , Vinod H. and Svensson، نويسنده , , Lars G. and Mack، نويسنده , , Michael J. and Miller، نويسنده , , D. Craig and Satler، نويسنده , , Lowell E. and Bavaria، نويسنده , , Joseph and Smith، نويسنده , , Craig R. and Leon، نويسنده , , Martin B. and Cohen، نويسنده , , David J.، نويسنده ,
Abstract :
Objectives
m of this study was to evaluate the cost-effectiveness of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (AVR) for patients with severe aortic stenosis and high surgical risk.
ound
s an alternative to AVR for patients with severe aortic stenosis and high surgical risk.
s
formed a formal economic analysis based on cost, quality of life, and survival data collected in the PARTNER A (Placement of Aortic Transcatheter Valves) trial in which patients with severe aortic stenosis and high surgical risk were randomized to TAVR or AVR. Cumulative 12-month costs (assessed from a U.S. societal perspective) and quality-adjusted life-years (QALYs) were compared separately for the transfemoral (TF) and transapical (TA) cohorts.
s
gh 12-month costs and QALYs were similar for TAVR and AVR in the overall population, there were important differences when results were stratified by access site. In the TF cohort, total 12-month costs were slightly lower with TAVR and QALYs were slightly higher such that TF-TAVR was economically dominant compared with AVR in the base case and economically attractive (incremental cost-effectiveness ratio <$50,000/QALY) in 70.9% of bootstrap replicates. In the TA cohort, 12-month costs remained substantially higher with TAVR, whereas QALYs tended to be lower such that TA-TAVR was economically dominated by AVR in the base case and economically attractive in only 7.1% of replicates.
sions
PARTNER trial, TAVR was an economically attractive strategy compared with AVR for patients suitable for TF access. Future studies are necessary to determine whether improved experience and outcomes with TA-TAVR can improve its cost-effectiveness relative to AVR. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894)
