Early TAVR was economically dominant over clinical surveillance for asymptomatic severe aortic stenosis, providing 0.24 additional QALYs and lowering lifetime costs by $8,812.
Does early transcatheter aortic valve replacement improve cost-effectiveness compared to clinical surveillance in patients with asymptomatic severe aortic stenosis?
Early TAVR is projected to be an economically dominant (cost-saving and more effective) strategy compared to clinical surveillance for asymptomatic severe aortic stenosis in the US healthcare system.
OBJECTIVES The EARLY TAVR trial demonstrated improved clinical outcomes for patients with asymptomatic severe aortic stenosis (aSAS) treated with transcatheter aortic valve replacement (eTAVR) compared with clinical surveillance (CS). The cost effectiveness of an eTAVR strategy for patients with aSAS in the United States (US) is unknown. METHODS A Markov model with 30-day cycles was developed from the US healthcare payor perspective to estimate the cost-effectiveness of eTAVR vs. CS over a lifetime horizon. Inputs for population characteristics and health outcomes were derived from the EARLY TAVR trial. Costs were derived from US Medicare reimbursement rates. Probabilistic and deterministic sensitivity analyses were performed to evaluate the effect of parameter uncertainty on model output. RESULTS When compared to CS, eTAVR was associated with 0. 21 additional life years (LY) and 0. 24 additional quality-adjusted life years (QALYs) over a lifetime due to more time spent in the alive and well health state with eTAVR. Lifetime costs were estimated to be 8, 812 lower, due primarily to reductions in costs associated with the AVR procedure, stroke, and heart failure hospitalizations. Accordingly, eTAVR was projected to be economically dominant over CS. In probabilistic sensitivity analysis, a large majority of iterations (95. 9%) produced cost-effective results (100, 000 threshold) for eTAVR versus CS, with most simulations (90. 3%) showing dominance, confirming the robustness of the base case results. These findings were consistent over a variety of scenario analyses. CONCLUSIONS An eTAVR strategy for the treatment of aSAS may be a cost-saving approach for US healthcare payors, when compared to CS.
Généreux et al. (2026) studied Asymptomatic severe aortic stenosis (aSAS). Transcatheter aortic valve replacement (eTAVR) vs. Clinical surveillance (CS) was evaluated on Cost-effectiveness (life years, QALYs, and lifetime costs). Early TAVR was economically dominant over clinical surveillance for asymptomatic severe aortic stenosis, providing 0.24 additional QALYs and lowering lifetime costs by $8,812.