Cost-effectiveness of transcatheter aortic valve implantation for asymptomatic severe aortic stenosis in the Kingdom of Saudi Arabia

Introduction Aortic stenosis (AS) is defined as the narrowing of the aortic valve. The benefits of implementing early aortic valve replacement (AVR), while the AS is asymptomatic, have been demonstrated in various clinical trials compared with clinical surveillance (CS) of delayed AVR upon symptom onset. The study aims to estimate the cost-effectiveness of transcatheter aortic valve implantation (TAVI) for the treatment of asymptomatic severe aortic stenosis (aSAS) in the Kingdom of Saudi Arabia (KSA). Methods A cost–utility analysis compared TAVI using the SAPIEN 3/SAPIEN 3 Ultra valve with CS in an aSAS population. A Markov model consisting of three health states—alive and well, stroke, and death—captured the peri-procedural and long-term outcomes across a lifetime horizon. Inputs were derived from the EARLY TAVR trial (NCT03042104) and existing literature. Results The model findings estimated that TAVI was cost-saving and more effective (dominant) compared with CS for people with aSAS, with a 97.3% probability of being cost-effective. Incremental results per person included an estimated cost saving of SAR 33,414, an estimated quality-adjusted life year gain of 0.17, and an estimated life-year gain of 0.12. The key driver of the model was the weighting of disabling stroke for the CS arm. Conclusion Early implementation of TAVI for those with aSAS is estimated to result in reduced costs and greater benefits compared with CS. These findings support the idea that timely intervention could enhance AS disease management in line with KSA policy.