Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis: Results of the PARTNER (Placement of Aortic Transcatheter Valves) Trial (Cohort A)

• Published in: Journal of the American College of Cardiology Vol. 60; no. 25; pp. 2683 - 2692
• Main Authors: REYNOLDS, Matthew R, MAGNUSON, Elizabeth A, MACK, Michael J, CRAIG MILLER, D, SATLER, Lowell E, BAVARIA, Joseph, SMITH, Craig R, LEON, Martin B, COHEN, David J, YANG LEI, KAIJUN WANG, VILAIN, Katherine, HAIYAN LI, WALCZAK, Joshua, PINTO, Duane S, THOURANI, Vinod H, SVENSSON, Lars G
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 25.12.2012
• Subjects: Aged, 80 and over; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - economics; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiac Catheterization - economics; Cardiology. Vascular system; Cost-Benefit Analysis; Endocardial and cardiac valvular diseases; Female; Heart; Heart Valve Prosthesis Implantation - economics; Heart Valve Prosthesis Implantation - methods; Humans; Male; Medical sciences; Quality-Adjusted Life Years; Risk Factors; Severity of Illness Index; Treatment Outcome; United States; United States; Human; High risk; Aortic stenosis; Cardiovascular disease; Patient; Replacement; Result; Treatment; Cardiac valvular disease; Health economy; Surgery; Circulatory system; Cardiology; Severe; Aortic valve; Public health; Comparative study; Cost efficiency analysis
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2012.09.018

The aim 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. TAVR is an alternative to AVR for patients with severe aortic stenosis and high surgical risk. We performed 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. Although 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. In the 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.