Transcatheter aortic valve implantation versus surgical aortic valve replacement in severe aortic stenosis patients at low surgical mortality risk: a cost-effectiveness analysis in Belgium.
Transcatheter aortic valve implantation versus surgical aortic valve replacement in severe aortic stenosis patients at low surgical mortality risk a_.pdf
[en] BACKGROUND: Transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 device has recently shown significant clinical benefits, compared to surgical aortic valve replacement (SAVR), in patients at low risk for surgical mortality (PARTNER 3 trial, NCT02675114). Currently in Belgium, TAVI use is restricted to high-risk or inoperable patients with severe symptomatic aortic stenosis (sSAS). This cost-utility analysis aimed to assess whether TAVI with SAPIEN 3 could lead to potential cost-savings compared with SAVR, in the low-risk sSAS population in Belgium. METHODS: A previously published, two-stage, Markov-based cost-utility model was used. Clinical outcomes were captured using data from PARTNER 3 and the model was adapted for the Belgian context using cost data from the perspective of the Belgian National Healthcare System, indexed to 2022. A lifetime horizon was chosen. The model outputs included changes in direct healthcare costs, survival and health-related quality of life using TAVI versus SAVR. RESULTS: TAVI with SAPIEN 3 provides meaningful clinical and cost benefits over SAVR, in terms of an increase in quality-adjusted life years (QALYs) of 0.94 and cost-saving of €3 013 per patient. While initial procedure costs were higher for TAVI compared with SAVR, costs related to rehabilitation, disabling stroke, treated atrial fibrillation, and rehospitalization were lower. The cost-effectiveness of TAVI over SAVR remained robust in sensitivity analyses. CONCLUSION: TAVI with SAPIEN 3 may offer a meaningful alternative intervention to SAVR in Belgian low-risk patients with sSAS, showing both clinical benefits and cost savings associated with post-procedure patient management.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Dubois, Christophe ; Department of Cardiovascular Medicine, Katholieke Universiteit Leuven, Department of Cardiovascular Sciences, University Hospital Leuven, Leuven, Belgium.
Adriaenssens, Tom; Department of Cardiovascular Medicine, Katholieke Universiteit Leuven, Department of Cardiovascular Sciences, University Hospital Leuven, Leuven, Belgium.
Annemans, Lieven; Faculty of Medicine, Department of Public Health, Ghent University, Ghent, Belgium.
Bosmans, Johan; University of Antwerp, Antwerpen, Belgium.
Callebaut, Britt; Hict, Ghent, Belgium.
Candolfi, Pascal ; Edwards Lifesciences SA, Nyon, Switzerland.
Cornelis, Kristoff; AZ Maria Middelares Gent, Ghent, Belgium.
Delbaere, Alexis; Edwards Lifesciences SA, Nyon, Switzerland.
Green, Michelle; York Health Economics Consortium, University of York, Heslington, UK.
Kefer, Joelle; Cliniques Universitaires Saint-Luc, IREC, University of Louvain, Brussels, Belgium.
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
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