Cost-utility analysis of TAVI compared with surgery in patients with severe aortic stenosis at low risk of surgical mortality in the Netherlands.

IF 1.7 4区医学 Q3 HEALTH POLICY & SERVICES Cost Effectiveness and Resource Allocation Pub Date : 2024-03-26 DOI:10.1186/s12962-024-00531-6

Rob Eerdekens, Suzanne Kats, Janneke Pc Grutters, Michelle Green, Judith Shore, Pascal Candolfi, Wija Oortwijn, Pim Van Der Harst, Pim Tonino

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Abstract

Background: There is growing evidence to support the benefits of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis (sSAS) who are at high- or intermediate-risk of surgical mortality. The PARTNER 3 trial showed clinical benefits with SAPIEN 3 TAVI compared with SAVR in patients at low risk of surgical mortality. Whether TAVI is also cost-effective compared with SAVR for low-risk patients in the Dutch healthcare system remains uncertain. This article presents an analysis using PARTNER 3 outcomes and costs data from the Netherlands to inform a cost-utility model and examine cost implications of TAVI over SAVR in a Dutch low-risk population.

Methods: A two-stage cost-utility analysis was performed using a published and validated health economic model based on adverse events with both TAVI and SAVR interventions from a published randomized low risk trial dataset, and a Markov model that captured lifetime healthcare costs and patient outcomes post-intervention. The model was adapted using Netherlands-specific cost data to assess the cost-effectiveness of TAVI and SAVR. Uncertainty was addressed using deterministic and probabilistic sensitivity analyses.

Results: TAVI generated 0.89 additional quality-adjusted life years (QALYs) at a €4742 increase in costs per patient compared with SAVR over a lifetime time horizon, representing an incremental cost-effectiveness ratio (ICER) of €5346 per QALY gained. Sensitivity analyses confirm robust results, with TAVI remaining cost-effective across several sensitivity analyses.

Conclusions: Based on the model results, compared with SAVR, TAVI with SAPIEN 3 appears cost-effective for the treatment of Dutch patients with sSAS who are at low risk of surgical mortality. Qualitative data suggest broader societal benefits are likely and these findings could be used to optimize appropriate intervention selection for this patient population.

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对荷兰手术死亡率风险较低的重度主动脉瓣狭窄患者进行 TAVI 与手术的成本效用分析。

背景：越来越多的证据表明，对于手术死亡率处于高风险或中风险的无症状重度主动脉瓣狭窄（sSAS）患者，经导管主动脉瓣植入术（TAVI）比手术主动脉瓣置换术（SAVR）更有益。PARTNER 3 试验显示，在手术死亡率风险较低的患者中，SAPIEN 3 TAVI 与 SAVR 相比具有临床优势。在荷兰的医疗体系中，对于低风险患者，TAVI 与 SAVR 相比是否也具有成本效益仍不确定。本文利用荷兰的 PARTNER 3 结果和成本数据进行分析，为成本效用模型提供信息，并研究在荷兰低风险人群中 TAVI 与 SAVR 相比的成本影响：方法：使用已公布和验证的健康经济模型进行了两阶段成本效用分析，该模型基于已公布的随机低风险试验数据集中 TAVI 和 SAVR 干预的不良事件，并使用马尔可夫模型捕捉干预后的终生医疗成本和患者预后。该模型利用荷兰特定的成本数据进行了调整，以评估 TAVI 和 SAVR 的成本效益。利用确定性和概率敏感性分析解决了不确定性问题：在终生时间范围内，TAVI 与 SAVR 相比，每名患者的成本增加了 4742 欧元，但却额外增加了 0.89 个质量调整生命年 (QALY)，即每获得一个质量调整生命年的增量成本效益比 (ICER) 为 5346 欧元。敏感性分析证实了这一稳健的结果，在多项敏感性分析中，TAVI仍具有成本效益：根据模型结果，与 SAVR 相比，对于手术死亡率风险较低的荷兰 sSAS 患者，使用 SAPIEN 3 进行 TAVI 治疗似乎具有成本效益。定性数据表明，可能会产生更广泛的社会效益，这些发现可用于优化该患者群体的适当干预选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cost Effectiveness and Resource Allocation HEALTH POLICY & SERVICES-

CiteScore

3.40

自引率

4.30%

发文量

审稿时长

34 weeks

期刊介绍： Cost Effectiveness and Resource Allocation is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of cost-effectiveness analysis, including conceptual or methodological work, economic evaluations, and policy analysis related to resource allocation at a national or international level. Cost Effectiveness and Resource Allocation is aimed at health economists, health services researchers, and policy-makers with an interest in enhancing the flow and transfer of knowledge relating to efficiency in the health sector. Manuscripts are encouraged from researchers based in low- and middle-income countries, with a view to increasing the international economic evidence base for health.