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Abstract
Objective To assess the cost-effectiveness of transcatheter aortic valve implantation (TAVI) compared with medical management in patients with severe aortic stenosis who are ineligible for conventional aortic valve replacement (SAVR) from the perspective of the UK National Health Service.
Design Probabilistic decision analytical model.
Methods A decision analytical model was developed to assess the costs and benefits associated with both interventions over a 10-year time horizon. A literature review was performed to identify relevant clinical evidence. Health-related quality of life and mortality were included using data from the PARTNER clinical trial (cohort B). Unit costs were taken from national databases. Costs and benefits were discounted at 3.5% per year, and extensive sensitivity analyses (probabilistic and deterministic) were performed to explore the impact of uncertainty on the cost-effectiveness estimates.
Main outcome measure Incremental cost-effectiveness ratio (ICER) with benefits expressed as quality-adjusted life years (QALYs).
Results The base case ICER was approximately £16 100 per QALY gained. At a cost-effectiveness threshold of £20 000 per QALY gained, the probability that TAVI was cost-effective compared with medical management was 1.00. The results were robust to changes in key clinical parameters as well as choice of baseline survival data. The observed PARTNER survival data only have to be extrapolated for 2 years to generate an ICER below £30 000 per QALY gained, which is the upper value of the threshold range used by the National Institute for Health and Clinical Excellence in the UK.
Conclusions TAVI is highly likely to be a cost-effective treatment for patients with severe aortic stenosis who are currently ineligible for SAVR.
- TAVI
- aortic stenosis
- cost-effectiveness
- ICER
- economic modelling
- basic science
- EBM
- quality of care and outcomes
- valvular disease
- interventional cardiology
- mitral regurgitation
- mitral valve prolapse
- prosthetic heart valves
- aortic valve disease
- minimally invasive
- surgery-valve
- antihypertensive drugs
- hypertension
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Footnotes
Funding The project was funded by Medtronic International Trading Sàrl. However, no restriction was placed on either the design of the model or the presentation of results.
Correction notice This paper has been corrected since it was published online first. The percentage of intraoperative death in paragraph 4 of ‘Description of model inputs’, ‘Estimating mortality’, has been corrected from 0.8% to 1.1%.
Competing interests MW, SM, JE and MS work for an international consultancy company and as such have received funding from numerous device and pharmaceutical companies to undertake studies similar to that presented in this paper. PB and RB are employees of Medtronic International Trading Sàrl. NP, NM and SP have received honoraria for the provision of expert advice throughout the project. MS, SP, NM and NP have undertaken consultancy for transcatheter aortic valve implantation (TAVI) manufacturers.
Provenance and peer review Not commissioned; externally peer reviewed.