Cost-effectiveness of transcatheter aortic valve implantation in patients at low surgical risk in France : a model-based analysis of the Evolut LR trial
© 2023. The Author(s)..
BACKGROUND: In the recent Evolut Low Risk randomized trial, transcatheter aortic valve implantation (TAVI) was shown to be non-inferior to surgery (SAVR) regarding the composite end point of all-cause mortality or disabling stroke at 24 months.
AIMS: To evaluate the cost-effectiveness of self-expandable TAVI in low-risk patients, using the French healthcare system as the basis for analysis.
METHODS: Mortality, health-related quality of life, and clinical event rates through two-year follow-up were derived from trial data (N = 725 TAVI and N = 678 SAVR; mean age: 73.9 years; mean STS-PROM: 1.9%). Cost inputs were based on real-world data for TAVI and SAVR procedures in the French healthcare system. Costs and effectiveness as quality-adjusted life years (QALYs) were projected to lifetime via a decision-analytic model under assumption of no mortality difference beyond two years. The discounted incremental cost-effectiveness ratio (ICER) was evaluated against a willingness-to-pay threshold of €50,000 per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted, including assumptions about differential long-term survival.
RESULTS: For the base case, mean survival was 13.69 vs 13.56 (+ 0.13) years for TAVI and SAVR, respectively. Discounted QALYs were 9.34 vs. 9.21 (+ 0.13) and discounted lifetime costs €52,267 vs. €51,433 (+ €833), resulting in a lifetime ICER of €6368 per QALY gained. In probabilistic sensitivity analysis, TAVI was found dominant or cost-effective in 74.4% of samples.
CONCLUSION: TAVI in patients at low surgical risk is a cost-effective alternative to SAVR in the French healthcare system. Longer follow-up data will help increase the accuracy of lifetime survival projections.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:25 |
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| Enthalten in: |
The European journal of health economics : HEPAC : health economics in prevention and care - 25(2024), 3 vom: 05. Apr., Seite 447-457 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tchétché, Didier [VerfasserIn] |
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| Links: |
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| Themen: |
Aortic valve stenosis |
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| Anmerkungen: |
Date Completed 28.03.2024 Date Revised 11.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s10198-023-01590-x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM357561481 |
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| 100 | 1 | |a Tchétché, Didier |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Cost-effectiveness of transcatheter aortic valve implantation in patients at low surgical risk in France |b a model-based analysis of the Evolut LR trial |
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| 500 | |a Date Revised 11.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a BACKGROUND: In the recent Evolut Low Risk randomized trial, transcatheter aortic valve implantation (TAVI) was shown to be non-inferior to surgery (SAVR) regarding the composite end point of all-cause mortality or disabling stroke at 24 months | ||
| 520 | |a AIMS: To evaluate the cost-effectiveness of self-expandable TAVI in low-risk patients, using the French healthcare system as the basis for analysis | ||
| 520 | |a METHODS: Mortality, health-related quality of life, and clinical event rates through two-year follow-up were derived from trial data (N = 725 TAVI and N = 678 SAVR; mean age: 73.9 years; mean STS-PROM: 1.9%). Cost inputs were based on real-world data for TAVI and SAVR procedures in the French healthcare system. Costs and effectiveness as quality-adjusted life years (QALYs) were projected to lifetime via a decision-analytic model under assumption of no mortality difference beyond two years. The discounted incremental cost-effectiveness ratio (ICER) was evaluated against a willingness-to-pay threshold of €50,000 per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted, including assumptions about differential long-term survival | ||
| 520 | |a RESULTS: For the base case, mean survival was 13.69 vs 13.56 (+ 0.13) years for TAVI and SAVR, respectively. Discounted QALYs were 9.34 vs. 9.21 (+ 0.13) and discounted lifetime costs €52,267 vs. €51,433 (+ €833), resulting in a lifetime ICER of €6368 per QALY gained. In probabilistic sensitivity analysis, TAVI was found dominant or cost-effective in 74.4% of samples | ||
| 520 | |a CONCLUSION: TAVI in patients at low surgical risk is a cost-effective alternative to SAVR in the French healthcare system. Longer follow-up data will help increase the accuracy of lifetime survival projections | ||
| 650 | 4 | |a Clinical Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Aortic valve stenosis | |
| 650 | 4 | |a Cost–benefit analysis | |
| 650 | 4 | |a France | |
| 650 | 4 | |a Health-related quality of life | |
| 650 | 4 | |a Surgical aortic valve replacement | |
| 650 | 4 | |a Transcatheter aortic valve implantation | |
| 700 | 1 | |a de Gennes, Coline Dubois |e verfasserin |4 aut | |
| 700 | 1 | |a Cormerais, Quentin |e verfasserin |4 aut | |
| 700 | 1 | |a Geisler, Benjamin P |e verfasserin |4 aut | |
| 700 | 1 | |a Dutot, Camille |e verfasserin |4 aut | |
| 700 | 1 | |a Wilquin-Bequet, Fanny |e verfasserin |4 aut | |
| 700 | 1 | |a Breau-Brunel, Manon |e verfasserin |4 aut | |
| 700 | 1 | |a Lueza, Béranger |e verfasserin |4 aut | |
| 700 | 1 | |a Pietzsch, Jan B |e verfasserin |4 aut | |
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