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Transcatheter aortic valve implantation against conventional aortic valve replacement surgery in high-risk patients with aortic stenosis ; a cost-effectiveness analysis
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Ghiasvand, Hesam, Khaleghparast, Shiva, Kachoueian, Naser, Tirgarfakheri, Kourosh, Mortazian, Meysam, Toloueitabar, Yaser, Gorjipour, Farhad and Naghdi, Seyran (2023) Transcatheter aortic valve implantation against conventional aortic valve replacement surgery in high-risk patients with aortic stenosis ; a cost-effectiveness analysis. Health Economics Review, 13 . 1. doi:10.1186/s13561-022-00411-w ISSN 2191-1991.
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Official URL: https://doi.org/10.1186/s13561-022-00411-w
Abstract
Background:
Aortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in financial resources, it is crucial to investigate the cost-effectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-effectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery.
Methods:
This study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran’s national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty.
Results:
The incremental cost, effectiveness, and cost-effectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$ 1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-effective at one and three times the country’s Gross Domestic Production (GDP) is 0.31 and 0.83, respectively.
Conclusions:
TAVI does not seem a cost-effective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-effective will raise to 83%.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RD Surgery | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | ||||||
Library of Congress Subject Headings (LCSH): | Aortic valve -- Surgery -- Cost effectiveness, Aortic valve -- Stenosis -- Surgery | ||||||
Journal or Publication Title: | Health Economics Review | ||||||
Publisher: | Springer Berlin Heidelberg | ||||||
ISSN: | 2191-1991 | ||||||
Official Date: | 3 January 2023 | ||||||
Dates: |
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Volume: | 13 | ||||||
Article Number: | 1 | ||||||
DOI: | 10.1186/s13561-022-00411-w | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Description: | The Correction to this article has been published in Health Economics Review 2023 13:6 |
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Date of first compliant deposit: | 24 January 2023 | ||||||
Date of first compliant Open Access: | 24 January 2023 | ||||||
RIOXX Funder/Project Grant: |
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