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Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis:

Results of the PARTNER (Placement of Aortic Transcatheter Valves) Trial (Cohort A)

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.

Valvular Heart Diseases


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.

Conclusion:

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. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; )

Notes to editor


Matthew R. Reynolds, Elizabeth A. Magnuson, Yang Lei, Kaijun Wang, Katherine Vilain, Haiyan Li, Joshua Walczak, Duane S. Pinto, Vinod H. Thourani, Lars G. Svensson, Michael J. Mack, D. Craig Miller, Lowell E. Satler, Joseph Bavaria, Craig R. Smith, Martin B. Leon, David J. Cohen, PARTNER Investigators
Original Research Article
Pages 2683-2692

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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