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. 2014 Oct 23;1(1):e000155.
doi: 10.1136/openhrt-2014-000155. eCollection 2014.

Cost-utility of transcatheter aortic valve implantation for inoperable patients with severe aortic stenosis treated by medical management: a UK cost-utility analysis based on patient-level data from the ADVANCE study

Stephen Brecker  1 , Stuart Mealing  2 , Amie Padhiar  2 , James Eaton  2 , Mark Sculpher  2 , Rachele Busca  3 , Johan Bosmans  4 , Ulrich J Gerckens  5 , Peter Wenaweser  6 , Corrado Tamburino  7 , Sabine Bleiziffer  8 , Nicolo Piazza  9 , Neil Moat  10 , Axel Linke  11
Affiliations

Cost-utility of transcatheter aortic valve implantation for inoperable patients with severe aortic stenosis treated by medical management: a UK cost-utility analysis based on patient-level data from the ADVANCE study

Stephen Brecker et al. Open Heart. .

Abstract

Objective: To use patient-level data from the ADVANCE study to evaluate the cost-effectiveness of transcatheter aortic valve implantation (TAVI) compared to medical management (MM) in patients with severe aortic stenosis from the perspective of the UK NHS.

Methods: A published decision-analytic model was adapted to include information on TAVI from the ADVANCE study. Patient-level data informed the choice as well as the form of mathematical functions that were used to model all-cause mortality, health-related quality of life and hospitalisations. TAVI-related resource use protocols were based on the ADVANCE study. MM was modelled on publicly available information from the PARTNER-B study. The outcome measures were incremental cost-effectiveness ratios (ICERs) estimated at a range of time horizons with benefits expressed as quality-adjusted life-years (QALY). Extensive sensitivity/subgroup analyses were undertaken to explore the impact of uncertainty in key clinical areas.

Results: Using a 5-year time horizon, the ICER for the comparison of all ADVANCE to all PARTNER-B patients was £13 943 per QALY gained. For the subset of ADVANCE patients classified as high risk (Logistic EuroSCORE >20%) the ICER was £17 718 per QALY gained). The ICER was below £30 000 per QALY gained in all sensitivity analyses relating to choice of MM data source and alternative modelling approaches for key parameters. When the time horizon was extended to 10 years, all ICERs generated in all analyses were below £20 000 per QALY gained.

Conclusion: TAVI is highly likely to be a cost-effective treatment for patients with severe aortic stenosis.

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Figures

Figure 1
Figure 1
Model schematic (TAVI, transcatheter aortic valve implantation).
Figure 2
Figure 2
(A) Within trial goodness of fit for main patient groups. (B) Long-term extrapolation for all main patient groups (TAVI, transcatheter aortic valve implantation).
Figure 3
Figure 3
Cost-effectiveness plane for all PARTNER-B vs all ADVANCE and all PARTNER vs ADVANCE high risk comparisons with ICERs from five studies; dashed line represents willingness to pay of £20 000 per QALY gained (ICER, incremental cost-effectiveness ratio; MM, medical management; QALY, quality-adjusted life-years; CABG, coronary artery bypass graft; HF, heart failure; CRT, cardiac resynchronization therapy).
Figure 4
Figure 4
Deterministic univariate sensitivity analyses (BAV, balloon aortic valvuloplasty; ICU, intensive care unit; MM, medical management; QALY, quality-adjusted life-years; TAVI, transcatheter aortic valve implantation).
See this image and copyright information in PMC

References

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