WASHINGTON, D.C.—Transfemoral aortic valve implantation (TAVI) is a “very cost-effective” treatment option for aortic stenosis in elderly populations, based on a decision tree analysis presented Sept. 23 at the 22nd annual Transcatheter Cardiovascular Therapeutics (TCT) conference.
Tiffini Diage, MPH, from the University of Wisconsin Madison in Delafield, and her colleagues conducted a cost-effectiveness analysis comparing TAVI, surgical aortic valve replacement and a medical management approach. Utilizing a threshold of $100,000 per quality adjusted life year (QALY) and a third-party payor perspective, they sought to determine whether TAVI is a cost-effective alternative for managing aortic stenosis in elderly patients.
Diage explained that age-related degenerative calcification of the aortic valve is the most common cause of aortic stenosis in patients over 65 years. Untreated severe aortic stenosis has a mortality rate of 75 percent within three years.
The researchers constructed a decision tree. Adverse events that have significant long-term health consequences, such as stroke or a permanent pacemaker, were considered for each procedure arm. Peri-procedural and acute adverse events (MI, infection, atrial fibrillation and acute renal failure) were included in the hospitalization costs. Untreated patients and technical failures assume the cost for medical management of congestive heart failure, including syncope. The trial tracked costs over a three-year period.
TAVI had a total cost of $38,728 and total QALYs of 2.05 with an incremental cost of $6,060 and 0.83 QALYs (compared with medical management), Diage reported. Likewise, surgical aortic valve replacement had a total cost of $76,340 and 2.62 with an incremental cost of $37,558 and 0.57 QALYs (compared with TAVI). Therefore, “no option is dominant,” she said.
Therefore, Diage said that TAVI is a “very cost-effective option” compared with a medical management approach, considering its “relatively small” incremental cost-effectiveness ratio of $7,269. “Surgical aortic valve replacement is less cost effective, but is still below the threshold for what payors may deem cost effective when the uncertainty factors for probability outcomes are applied,” she noted.
The researchers concluded that their model supports the use of TAVI in high-risk patient populations, as it “significantly reduces morbidity and associated costs. While long-term percutaneous valve durability is unproven, these results support the notion of researching TAVI utilization in younger, healthier patient populations.”
Several of the researchers, including Diage, disclosed relationships with Embrella Cardiovascular.