Key result
Transcatheter aortic valve replacement was unlikely to be cost-effective compared with surgical replacement in low-risk severe aortic stenosis (ICER Int$ 64,617 per QALY gained).
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Why the study?
Although TAVR demonstrated noninferiority to SAVR in low surgical risk severe aortic stenosis, it remains costly, and its cost-effectiveness in low- and middle-income public health systems was unknown.
Is TAVR cost-effective compared to SAVR in patients with severe aortic stenosis at low surgical risk from the perspective of the Brazilian public health system?
Is TAVR cost-effective compared to SAVR in patients with severe aortic stenosis at low surgical risk from the perspective of the Brazilian public health system?
TAVR is unlikely to be cost-effective compared to SAVR for low-surgical-risk patients with severe aortic stenosis in the Brazilian public health system due to high procedural costs.
May support surgical replacement over TAVR in low-risk severe aortic stenosis; leaves open the need for updated economic evaluations.
BACKGROUND: Randomized controlled trials comparing transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis and low surgical risk have demonstrated noninferiority of TAVR regarding all-cause mortality and stroke outcomes in 5- and 10-year follow-up. Nevertheless, TAVR remains a costly intervention, and its widescale adoption may affect healthcare expenditure in low- and middle-income countries. This study aimed to conduct a cost-utility analysis comparing TAVR and SAVR in patients with severe aortic stenosis at low surgical risk, from the perspective of the Brazilian Unified Health System (Sistema Único de Saúde - SUS). METHODS: A Markov model was developed to simulate a hypothetical cohort of patients with severe aortic stenosis over a lifetime horizon. A systematic review was performed to inform efficacy and effectiveness inputs. Cost data were derived from Brazilian patient cohorts who underwent TAVR or SAVR and were expressed in international dollars (Int$). Incremental cost-effectiveness ratios (ICERs) were calculated and sensitivity analyses were performed. RESULTS: The estimated lifetime cost was Int$ 32,341 for TAVR and Int$ 19,778 for SAVR. Lifetime quality-adjusted life-years (QALYs) were 9.90 and 9.71, respectively. The ICER for TAVR was Int$ 64,617 per QALY gained, exceeding the Brazilian willingness-to-pay threshold of Int$ 47,619 per QALY. In probabilistic sensitivity analysis, TAVR was cost-effective in 32.8% of simulations. CONCLUSION: In patients with severe aortic stenosis at low surgical risk, TAVR was unlikely to be cost-effective compared with SAVR from the perspective of the Brazilian Unified Health System, primarily driven by cost differences between strategies.
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Pereira et al. (2026) studied severe aortic stenosis. Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Incremental cost-effectiveness ratio (ICER) (ICER Int$ 64,617 per QALY gained). Transcatheter aortic valve replacement was unlikely to be cost-effective compared with surgical replacement in low-risk severe aortic stenosis (ICER Int$ 64,617 per QALY gained).
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