Key result
TAVI with SAPIEN 3 was dominant compared with SAVR, providing cost savings of €12,742 per patient and generating 0.89 more quality-adjusted life-years per patient.
Why the study?
Following clinical benefits demonstrated in the PARTNER 3 trial, the cost implications of TAVI compared with SAVR in patients with severe aortic stenosis at low risk of surgical mortality needed evaluation in France.
Does transcatheter aortic valve implantation (TAVI) with SAPIEN 3 improve cost-effectiveness compared to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis at low risk of surgical mortality?
Does transcatheter aortic valve implantation (TAVI) with SAPIEN 3 improve cost-effectiveness compared to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis at low risk of surgical mortality?
Effect estimate: cost saving €12 742 and 0.89 QALYs per patient
TAVI with SAPIEN 3 is a cost-saving and dominant strategy compared to SAVR for patients with severe symptomatic aortic stenosis at low surgical risk in the French healthcare system.
TAVI with SAPIEN 3 may dominate SAVR economically in low-risk severe AS; extends modeling data but leaves confirmation to prospective trials.
OBJECTIVES: The clinical and cost-saving benefits of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis who are at high or intermediate risk of surgical mortality are supported by a growing evidence base. The PARTNER 3 trial (Placement of AoRTic TraNscathetER Valve Trial) demonstrated clinical benefits with SAPIEN 3 TAVI compared with SAVR in selected patients at low risk of surgical mortality. This study uses PARTNER 3 outcomes in combination with a French national hospital claim database to inform a cost-utility model and examine the cost implications of TAVI over SAVR in a low-risk population. METHODS: A 2-stage cost-utility analysis was developed to estimate changes in both direct healthcare costs and health-related quality of life using TAVI with SAPIEN 3 compared with SAVR. Early adverse events associated with TAVI were captured using the PARTNER 3 data set. These data fed into a Markov model that captured longer-term outcomes of patients, after TAVI or SAVR intervention. RESULTS: TAVI with SAPIEN 3 offers meaningful benefits over SAVR in providing both cost saving (€12 742 per patient) and generating greater quality-adjusted life-years (0.89 per patient). These results are robust with TAVI with SAPIEN 3 remaining dominant across several scenarios and deterministic and probabilistic sensitivity analyses. CONCLUSIONS: This model demonstrated that TAVI with SAPIEN 3 was dominant compared with SAVR in the treatment of patients with severe symptomatic aortic stenosis who are at low risk of surgical mortality. These findings should help policy makers in developing informed approaches to intervention selection for this patient population.
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Gilard et al. (2021) studied Severe aortic stenosis at low risk of surgical mortality. TAVI with SAPIEN 3 vs. Surgical aortic valve replacement (SAVR) was evaluated on Cost savings and quality-adjusted life-years (QALYs) (cost saving €12 742 and 0.89 QALYs per patient). TAVI with SAPIEN 3 was dominant compared with SAVR, providing cost savings of €12,742 per patient and generating 0.89 more quality-adjusted life-years per patient.
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