Global Cost-Effectiveness of Transcatheter vs. Surgical Aortic Valve Replacement in Severe Aortic Stenosis: A Systematic Review and Meta-Analysis.

Backgroud: Transcatheter aortic valve replacement (TAVR) is a less invasive treatment option for patients with severe aortic stenosis (AS); however, its economic benefits in patients with low to intermediate surgical risk remain controversial and vary by country. We conducted a systematic review to compare the economic benefits of TAVR versus surgical aortic valve replacement (SAVR).

Methods: We searched six databases, including PubMed, Medline, Scopus, Web of Science, Embase, and Clinical Trials for randomized controlled trials on the economic benefits of TAVR with different valve types and SAVR in symptomatic AS patients with low to intermediate surgical risk, from inception to October 2023. We extracted data on quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER), with ICER converted to 2023 United States dollars (USD) exchange rates.

Results: Fifteen studies met the inclusion criteria, with the overall quality ranging from intermediate to high. Among these, TAVR was found to be cost-effective in 14 studies, while in one study conducted in a developing country, TAVR was not cost-effective. When adjusted to 2023 USD, the ICER values ranged from $3,669 to $340,038 per QALY gained.

Conclusion: TAVR appears to be a cost-effective alternative to SAVR in patients with low to intermediate AS. In all studies, TAVR was associated with a significant increase in QALYs compared to SAVR. As it is an expensive procedure, the cost-effectiveness of TAVR depends on each country's ICER and willingness-to-pay threshold.