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).
BACKGROUND
In patients with severe aortic stenosis who cannot have surgery, transcatheter aortic valve replacement (TAVR) has been shown to improve survival and quality of life compared with standard therapy, but the costs and cost-effectiveness of this strategy are not yet known.


RESULTS
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 to estimate the incremental cost-effectiveness of TAVR from a US perspective. 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 versus $53 621) because of reduced hospitalization rates, but cumulative 1-year costs remained higher ($106 076 versus $53 621). We projected that over a patient's lifetime, TAVR would increase discounted life expectancy by 1.6 years (1.3 quality-adjusted life-years) 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 quality-adjusted life-year gained. These results were stable across a broad range of uncertainty and sensitivity analyses.


CONCLUSIONS
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.


BACKGROUND
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111, USA.
Matthew R
MR
Reynolds
Elizabeth A
EA
Magnuson
Kaijun
K
Wang
Yang
Y
Lei
Katherine
K
Vilain
Joshua
J
Walczak
Susheel K
SK
Kodali
John M
JM
Lasala
William W
WW
O'Neill
Charles J
CJ
Davidson
Craig R
CR
Smith
Martin B
MB
Leon
David J
DJ
Cohen
D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000191:economics / Q000401:mortality / Q000628:therapy; D006328:Cardiac Catheterization / Q000191:economics / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000191:economics / Q000379:methods / Q000401:mortality; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010820:Physicians / Q000191:economics / Q000706:statistics & numerical data; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016019:Survival Analysis