[Systematic Review: Validity and Transferability of the Results of Health-economic Evaluations of Transcatheter Aortic Valve Implantation]

Overview

Journal Wien Med Wochenschr

Specialty General Medicine

Date 2018 Aug 25

PMID 30141111

Authors

Sarah Wolf

Stefan Fischer

Affiliations

Soon will be listed here.

Abstract

Aim: To investigate health-economic evaluations of Transcatheter Aortic Valve Implantation (TAVI).

Methods: Systematic literature search of health-economic evaluations of TAVI comparing Standard Management (Medical Management in combination with Balloon Aortic Valvuloplasty) in inoperable patients and to Surgical Aortic Valve Replacement in operable patients with intermediate/high surgical risk. Incremental cost-effectiveness ratios have been adjusted to Austrian price level (2016). The studies were evaluated according to their relevance and quality.

Results: 15 health-economic evaluations were identified. Thereof, eight analyses were rated as sufficiently relevant and of high quality. Results showed that TAVI compared to Standard Management is cost-effective in only two out of six analyses and resulted in controversial results compared to Surgical Aortic Valve Replacement. Sensitivity analyses showed that particularly the inclusion of costs treating serious complications (i. e. stroke) or of the costs of the TAVI-procedure had significant impacts on the cost-effectiveness results.

References

Nixon J, Khan K, Kleijnen J . Summarising economic evaluations in systematic reviews: a new approach. BMJ. 2001; 322(7302):1596-8. PMC: 1120631. DOI: 10.1136/bmj.322.7302.1596. View

Faggiano P, Antonini-Canterin F, Baldessin F, Lorusso R, DAloia A, Cas L . Epidemiology and cardiovascular risk factors of aortic stenosis. Cardiovasc Ultrasound. 2006; 4:27. PMC: 1550260. DOI: 10.1186/1476-7120-4-27. View

Bonow R, Chatterjee K, de Leon Jr A, Gaasch W, Otto C, Shanewise J . 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing.... J Am Coll Cardiol. 2008; 52(13):e1-142. DOI: 10.1016/j.jacc.2008.05.007. View

Leon M, Smith C, Mack M, Miller D, Moses J, Svensson L . Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363(17):1597-607. DOI: 10.1056/NEJMoa1008232. View

Dimarakis I, Rehman S, Grant S, Saravanan D, Levy R, Bridgewater B . Conventional aortic valve replacement for high-risk aortic stenosis patients not suitable for trans-catheter aortic valve implantation: feasibility and outcome. Eur J Cardiothorac Surg. 2011; 40(3):743-8. DOI: 10.1016/j.ejcts.2010.12.036. View

Smith C, Leon M, Mack M, Miller D, Moses J, Svensson L . Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011; 364(23):2187-98. DOI: 10.1056/NEJMoa1103510. View

Watt M, Mealing S, Eaton J, Piazza N, Moat N, Brasseur P . Cost-effectiveness of transcatheter aortic valve replacement in patients ineligible for conventional aortic valve replacement. Heart. 2011; 98(5):370-6. DOI: 10.1136/heartjnl-2011-300444. View

Reynolds M, Magnuson E, Wang K, Lei Y, Vilain K, Walczak J . Cost-effectiveness of transcatheter aortic valve replacement compared with standard care among inoperable patients with severe aortic stenosis: results from the placement of aortic transcatheter valves (PARTNER) trial (Cohort B). Circulation. 2012; 125(9):1102-9. DOI: 10.1161/CIRCULATIONAHA.111.054072. View

Gada H, Kapadia S, Tuzcu E, Svensson L, Marwick T . Markov model for selection of aortic valve replacement versus transcatheter aortic valve implantation (without replacement) in high-risk patients. Am J Cardiol. 2012; 109(9):1326-33. DOI: 10.1016/j.amjcard.2011.12.030. View

10.

Neyt M, Van Brabandt H, Devriese S, Van De Sande S . A cost-utility analysis of transcatheter aortic valve implantation in Belgium: focusing on a well-defined and identifiable population. BMJ Open. 2012; 2(3). PMC: 3358616. DOI: 10.1136/bmjopen-2012-001032. View

11.

Doble B, Blackhouse G, Goeree R, Xie F . Cost-effectiveness of the Edwards SAPIEN transcatheter heart valve compared with standard management and surgical aortic valve replacement in patients with severe symptomatic aortic stenosis: a Canadian perspective. J Thorac Cardiovasc Surg. 2012; 146(1):52-60.e3. DOI: 10.1016/j.jtcvs.2012.06.018. View

12.

Genereux P, Head S, Wood D, Kodali S, Williams M, Paradis J . Transcatheter aortic valve implantation 10-year anniversary: review of current evidence and clinical implications. Eur Heart J. 2012; 33(19):2388-98. DOI: 10.1093/eurheartj/ehs220. View

13.

Vahanian A, Alfieri O, Andreotti F, Antunes M, Baron-Esquivias G, Baumgartner H . Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012; 42(4):S1-44. DOI: 10.1093/ejcts/ezs455. View

14.

Reynolds M, Magnuson E, Lei Y, Wang K, Vilain K, Li H . Cost-effectiveness of transcatheter aortic valve replacement compared with surgical aortic valve replacement in high-risk patients with severe aortic stenosis: results of the PARTNER (Placement of Aortic Transcatheter Valves) trial (Cohort A). J Am Coll Cardiol. 2012; 60(25):2683-92. DOI: 10.1016/j.jacc.2012.09.018. View

15.

Walther T, Blumenstein J, Van Linden A, Kempfert J . Contemporary management of aortic stenosis: surgical aortic valve replacement remains the gold standard. Heart. 2012; 98 Suppl 4:iv23-9. DOI: 10.1136/heartjnl-2012-302399. View

16.

Murphy A, Fenwick E, Toff W, Neilson M, Berry C, Uren N . Transcatheter aortic valve implantation for severe aortic stenosis: the cost-effectiveness case for inoperable patients in the United Kingdom. Int J Technol Assess Health Care. 2013; 29(1):12-9. DOI: 10.1017/S0266462312000670. View

17.

Hancock-Howard R, Feindel C, Rodes-Cabau J, Webb J, Thompson A, Banz K . Cost effectiveness of transcatheter aortic valve replacement compared to medical management in inoperable patients with severe aortic stenosis: Canadian analysis based on the PARTNER Trial Cohort B findings. J Med Econ. 2013; 16(4):566-74. DOI: 10.3111/13696998.2013.770747. View

18.

Fairbairn T, Meads D, Hulme C, Mather A, Plein S, Blackman D . The cost-effectiveness of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at high operative risk. Heart. 2013; 99(13):914-20. DOI: 10.1136/heartjnl-2013-303722. View

19.

Simons C, Cipriano L, Shah R, Garber A, Owens D, Hlatky M . Transcatheter aortic valve replacement in nonsurgical candidates with severe, symptomatic aortic stenosis: a cost-effectiveness analysis. Circ Cardiovasc Qual Outcomes. 2013; 6(4):419-28. DOI: 10.1161/CIRCOUTCOMES.113.000280. View

20.

Gada H, Agarwal S, Marwick T . Perspective on the cost-effectiveness of transapical aortic valve implantation in high-risk patients: Outcomes of a decision-analytic model. Ann Cardiothorac Surg. 2013; 1(2):145-55. PMC: 3741749. DOI: 10.3978/j.issn.2225-319X.2012.06.12. View