title: Systematic review of the cost-effectiveness of transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment to aortic valve replacement (AVR) for selected patients with severe aortic stenosis. The present systematic review was conducted to analyze the cost-effectiveness of this novel technique within reimbursed healthcare systems.
  
  
  METHODS
  Two reviewers used 7 electronic databases from January 2000 to November 2012 to identify relevant cost-effectiveness studies of TAVI versus AVR or medical therapy. The primary endpoints were the incremental cost-effectiveness ratio (ICER) and the probability of cost-effectiveness. The eligible studies for the present systematic review included those in which the cost-effectiveness data were measured or projected for TAVI and either medical therapy or AVR. All forms of TAVI were included, and all retrieved publications were limited to the English language.
  
  
  RESULTS
  Eight studies were included for quantitative assessment. The ICER for TAVI compared with medical therapy for surgically inoperable patients ranged from US$26,302 to US$61,889 per quality-adjusted life year gained. The probability of TAVI being cost-effective compared with medical therapy ranged from 0.03 to 1.00. The ICER values for TAVI compared with AVR for high-risk surgical candidates ranged from US$32,000 to US$975,697 per quality-adjusted life year gained. The probability of TAVI being cost-effective in this cohort ranged from 0.116 to 0.709.
  
  
  CONCLUSIONS
  Depending on the ICER threshold selected, TAVI is potentially justified on both medical and economic grounds compared with medical therapy for patients deemed to be surgically inoperable. However, in the high-risk surgical patient cohort, the evidence is currently insufficient to economically justify the use of TAVI in preference to AVR.
authors.affiliation: Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia.
authors.forename: Praveen
authors.initials: P
authors.lastname: Indraratna
authors.affiliation: Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia.
authors.forename: Su C
authors.initials: SC
authors.lastname: Ang
authors.affiliation: Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: Hemal
authors.initials: H
authors.lastname: Gada
authors.affiliation: Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.affiliation: Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia.
authors.forename: Con
authors.initials: C
authors.lastname: Manganas
authors.affiliation: Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Bannon
authors.affiliation: Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia. Electronic address: drchriscao@gmail.com.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cao
mesh_terms: D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D006801:Humans; D018803:Models, Economic; D018579:Patient Selection; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome