The value of aortic valve replacement in elderly patients: an economic analysis.
OBJECTIVE
Economists have designed frameworks to measure the economic value of improvements in health and longevity. Heart valve replacement surgery has significantly prolonged life expectancy and quality of life. For the example of aortic valve replacement, what is its economic value according to this framework?


METHODS
From 1961 through 2003, a total of 4617 adult patients underwent aortic valve replacement by one team of cardiac surgeons. These patients were provided with a prospective lifetime follow-up service. As of 2005, observed follow-up was 31,671 patient-years, with a maximum of 41 years. A statistical model was used to generate the future life-years of patients currently alive. The value of life-years proposed by economists was applied to determine the economic value of the additional life given to these patients by aortic valve replacement.


RESULTS
The total life-years after aortic valve replacement were 53,323, with a gross value of 14.6 billion dollars. The total expected life-years without surgery were 10,157, with an estimated value of 3.0 billion dollars. Thus the net life-years gained by AVR were 43,166, worth 11.6 billion dollars. Subtracting the 451 million dollars total lifetime cost of surgery, the net value of the life-years gained by AVR was 11.2 billion dollars. The mean net value decreases according to age at surgery but is still worth 600,000 dollars for octogenarians and 200,000 dollars for nonagenarians.


CONCLUSIONS
According to the economic concept of the value of a statistical life, the return on the investment for aortic valve replacement is enormous for patients of all ages, even very elderly patients.
Wu
YingXing
Y
Providence Heart and Vascular Institute, Providence Health System, Portland, Ore 97225, USA. yingxing.wu@providence.org
Grunkemeier
Gary L
GL
Starr
Albert
A
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000191:economics / Q000401:mortality* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000191:economics* / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States