Cost Effectiveness of Transcatheter Aortic Valve Replacement Compared With Standard Care Among Inoperable Patients With Severe Aortic Stenosis: Results From The PARTNER Trial (Cohort B)

Feb 10, 2012
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Authors:
Reynolds MR, Magnuson EA, Wang K, et al.
Citation:
Circulation 2012;Feb 3:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What are the costs and cost-effectiveness of transcatheter aortic valve replacement (TAVR) as compared with standard therapy?

Methods:

The PARTNER trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgery to TAVR (n = 179) or standard therapy (n = 179). Empirical data regarding survival, quality of life, medical resource use, and hospital costs were collected during the trial and used to project life expectancy, quality-adjusted life expectancy, and lifetime medical care costs in order to estimate the incremental cost-effectiveness of TAVR from a US perspective.

Results:

For patients treated with TAVR, mean costs for the initial procedure and hospitalization were $42,806 and $78,542, respectively. Follow-up costs through 12 months were lower with TAVR ($29,289 vs. $53,621) due to reduced hospitalization rates, but cumulative 1-year costs remained higher ($106,076 vs. $53,621). The investigators projected that over a patient’s lifetime, TAVR would increase discounted life expectancy by 1.6 years (1.3 QALYs) at an incremental cost of $79,837. The incremental cost-effectiveness ratio for TAVR was thus estimated at $50,200 per year of life gained or $61,889 per QALY gained. These results were stable across a broad range of uncertainty and sensitivity analyses.

Conclusions:

The authors concluded that for patients with severe aortic stenosis who are not candidates for surgery, TAVR increases life expectancy at an incremental cost per life-year gained well within accepted values for commonly used cardiovascular technologies.

Perspective:

This trial-based analysis suggests that the incremental cost-effectiveness ratio for TAVR compared with standard care was estimated at $50,200 per year of life gained or ~$62,000 per QALY gained—results that remained relatively stable across a broad range of uncertainty and sensitivity analyses. Additional studies are indicated to evaluate the cost-effectiveness of TAVR for other lower-risk patient populations, and when compared with other treatment strategies (e.g., surgical AVR). Overall, the current study suggests that TAVR may be a good value in properly selected symptomatic patients with aortic stenosis who are at too high a risk to have surgical AVR.

Keywords: Uncertainty, Heart Valve Prosthesis, Hospital Costs, Cost-Benefit Analysis, Follow-Up Studies, Quality of Life, Cardiovascular Diseases, Quality-Adjusted Life Years, Transcatheter Aortic Valve Replacement


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