Key result
Tissue SAVR reduces long-term payer costs by ~$2400 vs mechanical valves in middle-aged patients.
Why the study?
Although mechanical valves are more durable, tissue SAVR valves avoid lifetime anticoagulation monitoring and may have lower rates of expensive sequelae, prompting an evaluation of payer costs in Thailand.
Does tissue SAVR reduce payer costs compared to mechanical SAVR in patients with severe aortic stenosis?
Does tissue SAVR reduce payer costs compared to mechanical SAVR in patients with severe aortic stenosis?
Tissue SAVR is associated with lower 25-year payer costs compared to mechanical SAVR in Thailand, as savings from reduced complications and anticoagulation monitoring offset higher reoperation costs.
Tissue SAVR may inform cost considerations for valve choice in middle-aged patients; leaves open need for prospective outcome validation.
OBJECTIVES: Surgical aortic valve replacement (SAVR) is an indicated treatment for severe aortic stenosis. Although mechanical valves are typically more durable, tissue SAVR valves do not require lifetime anticoagulation monitoring and may have lower rates of expensive sequelae. This economic evaluation estimates payer costs to the 3 largest Thai health insurance mechanisms for tissue versus mechanical SAVR. METHODS: A deterministic and Monte Carlo simulation model based on literature and expert opinion estimated total payer costs for tissue and mechanical valves over a 25-year duration for 3 separate age cohorts (45, 55, and 65 years). Reimbursements levels for hospitalization services were from the Thai Diagnosis Related Groups. Separate models are generated for the 3 main Thai health insurance mechanisms. RESULTS: The discounted expected 25-year reduction in payer savings associated with tissue SAVR are $2540, $2529, and $2311 per surgery for patients aged 45, 55, and 65 years, respectively, for the largest Thai insurer. Expected cost reductions associated with tissue SAVR are larger for each of the other schemes and generally decrease with patient age. Most savings accrue within 10 years of surgery. Reoperation costs are larger with tissue valves, but reductions in complications and anticoagulation monitoring more than offset these expenditures. Results are robust to multiple sensitivity and scenario analyses. CONCLUSIONS: Coverage and reimbursement of tissue valves can financially benefit Thai insurers and reduce expenditures in the Thai health system compared with mechanical valves. As tissue valve technology evolves and reoperation rates decline, the financial benefit associated with tissue valves will increase.
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Kittayarak et al. (2022) studied Severe aortic stenosis. Tissue surgical aortic valve replacement vs. Mechanical surgical aortic valve replacement was evaluated on Total payer costs over a 25-year duration. Tissue surgical aortic valve replacement reduced expected 25-year payer costs by $2311 to $2540 per surgery compared with mechanical valves for patients aged 45 to 65 years.
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