TAVI was the economically dominant strategy compared to clinical surveillance for asymptomatic severe aortic stenosis, with cost-effectiveness probabilities ranging from 97.3% to 99.9%.
Does early TAVI improve cost-effectiveness and health outcomes compared to clinical surveillance in patients with asymptomatic severe aortic stenosis?
Early intervention with TAVI for asymptomatic severe aortic stenosis is estimated to be economically dominant, delivering greater health benefits and reducing costs compared to clinical surveillance across nine European countries.
Aims: Asymptomatic severe aortic stenosis (aSAS) is associated with morbidity, with mortality increasing once symptoms develop. Benefits of early aortic valve replacement (AVR) over clinical surveillance (CS) with delayed AVR upon symptom onset have been demonstrated, and it is now recommended from the latest European Guidelines if procedural risk is low (Class IIa, Level A). The aim of this study is to estimate the economic impact of transcatheter aortic valve implantation (TAVI) for the treatment of aSAS. Methods and results: A cost-utility analysis compared TAVI using the SAPIEN 3/SAPIEN 3 Ultra valve vs. CS in patients with aSAS across nine European countries. A lifetime Markov model captured peri-procedural and long-term outcomes across three health states: alive and well, stroke, and death. Inputs were derived from the EARLY TAVR trial (NCT03042104) and literature sources. Clinical event rates were estimated via parametric survival analysis. Transcatheter aortic valve implantation treatment for patients with aSAS was modelled to be the economically dominant strategy for treating aSAS across all nine European healthcare systems, with cost-effectiveness probabilities ranging from 97.3% (UK) to 99.9% (Belgium). Incremental results per person included cost savings from -£1788 (UK) to -CHF15 802 (Switzerland), quality-adjusted life years gains of 0.18 (Germany, UK) to 0.23 (Switzerland), and life-year gains of 0.12 (UK) to 0.17 (Belgium). Annual discounting of upfront TAVI costs vs. delayed AVR costs drove results. Conclusion: For patients with aSAS, early intervention with TAVI is estimated to deliver greater health benefits and reduce costs compared with CS. These findings support policies promoting early detection and timely intervention before symptom onset.
“[The] findings support policies and the growing body of evidence promoting the early detection of AS [aortic stenosis] and timely intervention before symptom onset, as opposed to providing CS [clinical surveillance] with a delayed AVR [aortic valve replacement ] procedure.”
Généreux et al. (Wed,) conducted a other in Asymptomatic severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) vs. Clinical surveillance (CS) with delayed AVR was evaluated on Cost-effectiveness. TAVI was the economically dominant strategy compared to clinical surveillance for asymptomatic severe aortic stenosis, with cost-effectiveness probabilities ranging from 97.3% to 99.9%.