Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Severe Aortic Stenosis

Background Recent studies have shown that transcatheter aortic valve implantation (TAVI) is non-inferior to surgical aortic valve replacement (SAVR) for treatment of low-risk patients with severe aortic stenosis (AS). However, the costeffectiveness of TAVI in this population is unknown. We sought to evaluate the cost-effectiveness of both balloon expandable and self-expanding TAVI compared to SAVR in patients with severe AS at low operative risk. Methods We developed a Markov model comparing TAVI to SAVR over a lifetime horizon. Key data inputs were drawn from the Placement of AoRTic TraNscathetER Valve (PARTNER) 3 trial for balloon-expandable TAVI and the Evolut Low-Risk trial for self-expanding TAVI. Costs were obtained from Australian sources. The perspective was that of the Australian health care system. Results Although procedural costs were higher for TAVI compared to SAVR, these were offset by a shorter length of hospitalisation and lower acute complication costs in the TAVI group. Over a lifetime horizon, balloon expandable TAVI was associated with increased costs of A$702 compared to SAVR, and increased quality-adjusted survival by 0.20 years, yielding an incremental cost-effectiveness ratio of A$3,521 per quality-adjusted life year (QALY) saved. Self-expanding TAVI was associated with lower lifetime costs compared to SAVR, and increased quality-adjusted survival by 0.08 years, and was therefore economically dominant. In probabilistic sensitivity analyses, balloon-expandable TAVI was cost-effective in 78% of iterations (at a cost-effectiveness threshold of A$50,000 per QALY gained) and self-expanding TAVI was costeffective in 70% of iterations. Conclusions Among low-risk AS patients, both balloon-expandable and self-expanding TAVI are likely to be costeffective relative to SAVR.

Automated summary

Recent studies suggest that balloon-expandable and self-expanding TAVI may offer cost-effective options compared to SAVR for low-risk patients with severe aortic stenosis. While balloon-expandable TAVI showed higher quality-adjusted survival years but higher costs, self-expanding TAVI was found to be economically dominant with lower costs and slightly lower increase in quality-adjusted survival years.