Transfemoral TAVR was economically dominant compared with surgical AVR (ICER <$50,000/QALY in 70.9% of replicates), whereas transapical TAVR was economically dominated by AVR.
RCT
Does transcatheter aortic valve replacement improve cost-effectiveness compared to surgical aortic valve replacement in high-risk patients with severe aortic stenosis?
Transfemoral TAVR is an economically dominant and attractive strategy compared with surgical AVR in high-risk patients with severe aortic stenosis, whereas transapical TAVR is not.
OBJECTIVES: The aim of this study was to evaluate the cost-effectiveness of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (AVR) for patients with severe aortic stenosis and high surgical risk. BACKGROUND: TAVR is an alternative to AVR for patients with severe aortic stenosis and high surgical risk. METHODS: We performed a formal economic analysis based on cost, quality of life, and survival data collected in the PARTNER A (Placement of Aortic Transcatheter Valves) trial in which patients with severe aortic stenosis and high surgical risk were randomized to TAVR or AVR. Cumulative 12-month costs (assessed from a U. S. societal perspective) and quality-adjusted life-years (QALYs) were compared separately for the transfemoral (TF) and transapical (TA) cohorts. RESULTS: Although 12-month costs and QALYs were similar for TAVR and AVR in the overall population, there were important differences when results were stratified by access site. In the TF cohort, total 12-month costs were slightly lower with TAVR and QALYs were slightly higher such that TF-TAVR was economically dominant compared with AVR in the base case and economically attractive (incremental cost-effectiveness ratio <50, 000/QALY) in 70. 9% of bootstrap replicates. In the TA cohort, 12-month costs remained substantially higher with TAVR, whereas QALYs tended to be lower such that TA-TAVR was economically dominated by AVR in the base case and economically attractive in only 7. 1% of replicates. CONCLUSIONS: In the PARTNER trial, TAVR was an economically attractive strategy compared with AVR for patients suitable for TF access. Future studies are necessary to determine whether improved experience and outcomes with TA-TAVR can improve its cost-effectiveness relative to AVR.
Reynolds et al. (2012) conducted an RCT in Severe aortic stenosis. Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (AVR) was evaluated on Cumulative 12-month costs and quality-adjusted life-years (QALYs). Transfemoral TAVR was economically dominant compared with surgical AVR (ICER <$50,000/QALY in 70.9% of replicates), whereas transapical TAVR was economically dominated by AVR.