TAVR cost-effective for inoperable aortic stenosis
MedWire News: Transcatheter aortic valve replacement (TAVR) may provide a cost-effective solution for patients with severe aortic stenosis (AS) who are unable to have surgery, according to US study results.
The results show that TAVR increases the life-expectancy of inoperable AS patients by more than 18 months, at an estimated cost of US$ 50,200 (€ 37,619) per year of life gained.
This value, say David Cohen (University of Missouri-Kansas City School of Medicine) and team, is "well within accepted values for commonly used cardiovascular technologies."
Patients enrolled into the Placement of Aortic Transcatheter Valves (PARTNER) trial were included in the cost-analysis. All had severe AS and were deemed to be at too high a risk to undergo conventional surgical aortic valve replacement.
Patients were randomly allocated to receive TAVR (n=179) or standard therapy (balloon aortic valvuloplasty or pharmaceutical management of symptoms at the discretion of the treating physician; n=179).
Patient survival rates, quality of life, hospital costs, and medical resources use were monitored over a mean period of 18 months. These factors were then used to estimate life expectancy, quality-adjusted life expectancy, and lifetime medical care costs, from which the incremental cost-effectiveness of TAVR was determined.
As reported in the journal Circulation, TAVR-treated patients incurred twofold higher total 1-year post-intervention costs than those treated with standard therapy, at respective rates of US$ 106,076 (€ 79,493) and $ 53,621 (€ 40,183).
TAVR increased discounted life expectancy by 1.6 years, costing an estimated US$ 50,200 (€ 37,619) per year of life gained and US$ 61,889 (€ 46,379) per quality-adjusted life-year.
This TAVR-specific cost falls within the US expenditure range associated with other cardiovascular therapy devices, such as implantable defibrillators for primary prevention of sudden cardiac death and catheter ablation for atrial fibrillation, remark Cohen and team.
They highlight, however, that the cost-effectiveness of TAVR does not extend far beyond the first postintervention year.
Indeed, the costs associated with TAVR increase markedly after the first year because ongoing medical care for patients who survive for several years after AS intervention is extremely expensive, explain Cohen and colleagues.
They conclude: "Further studies will be necessary to evaluate the cost-effectiveness of TAVR for other, lower-risk patient populations and compared with other treatment strategies (eg, surgical aortic valve replacement)."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Lauretta Ihonor