title: 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).
abstract: OBJECTIVE
  The aim of this study was to evaluate the cost-effectiveness of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (AVR) for patients with severe aortic stenosis and high surgical risk.
  
  
  BACKGROUND
  TAVR is an alternative to AVR for patients with severe aortic stenosis and high surgical risk.
  
  
  METHODS
  We performed a formal economic analysis based on cost, quality of life, and survival data collected in the PARTNER A (Placement of Aortic Transcatheter Valves) trial in which patients with severe aortic stenosis and high surgical risk were randomized to TAVR or AVR. Cumulative 12-month costs (assessed from a U.S. societal perspective) and quality-adjusted life-years (QALYs) were compared separately for the transfemoral (TF) and transapical (TA) cohorts.
  
  
  RESULTS
  Although 12-month costs and QALYs were similar for TAVR and AVR in the overall population, there were important differences when results were stratified by access site. In the TF cohort, total 12-month costs were slightly lower with TAVR and QALYs were slightly higher such that TF-TAVR was economically dominant compared with AVR in the base case and economically attractive (incremental cost-effectiveness ratio <$50,000/QALY) in 70.9% of bootstrap replicates. In the TA cohort, 12-month costs remained substantially higher with TAVR, whereas QALYs tended to be lower such that TA-TAVR was economically dominated by AVR in the base case and economically attractive in only 7.1% of replicates.
  
  
  CONCLUSIONS
  In the PARTNER trial, TAVR was an economically attractive strategy compared with AVR for patients suitable for TF access. Future studies are necessary to determine whether improved experience and outcomes with TA-TAVR can improve its cost-effectiveness relative to AVR.
authors.affiliation: Harvard Clinical Research Institute, Boston, Massachusetts, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Reynolds
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Magnuson
authors.forename: Yang
authors.initials: Y
authors.lastname: Lei
authors.forename: Kaijun
authors.initials: K
authors.lastname: Wang
authors.forename: Katherine
authors.initials: K
authors.lastname: Vilain
authors.forename: Haiyan
authors.initials: H
authors.lastname: Li
authors.forename: Joshua
authors.initials: J
authors.lastname: Walczak
authors.forename: Duane S
authors.initials: DS
authors.lastname: Pinto
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
authors.forename: Lowell E
authors.initials: LE
authors.lastname: Satler
authors.forename: Joseph
authors.initials: J
authors.lastname: Bavaria
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D006328:Cardiac Catheterization / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000191:economics* / Q000379:methods; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States