title: Transfemoral transcatheter aortic valve replacement compared with surgical replacement in patients with severe aortic stenosis and comparable risk: cost-utility and its determinants.
abstract: OBJECTIVE
  To evaluate cost-effectiveness of transfemoral TAVR vs surgical replacement (SAVR) and its determinants in patients with severe symptomatic aortic stenosis and comparable risk.
  
  
  METHODS
  Patients were prospectively recruited in 6 Spanish hospitals and followed up over one year. We estimated adjusted incremental cost-effectiveness ratio (ICER) (Euros per quality-adjusted life-year [QALY] gained) using a net-benefit approach and assessed the determinants of incremental net-benefit of TAVR vs SAVR.
  
  
  RESULTS
  We analyzed data on 207 patients: 58, 87 and 62 in the Edwards SAPIEN (ES) TAVR, Medtronic-CoreValve (MC) TAVR and SAVR groups respectively. Average cost per patient of ES-TAVR was €8800 higher than SAVR and the gain in QALY was 0.036. The ICER was €148,525/QALY. The cost of MC-TAVR was €9729 higher than SAVR and the QALY difference was -0.011 (dominated). Results substantially changed in the following conditions: 1) in patients with high preoperative serum creatinine the ICERs were €18,302/QALY and €179,618/QALY for ES and MC-TAVR respectively; 2) a 30% reduction in the cost of TAVR devices decreased the ICER for ES-TAVR to €32,955/QALY; and 3) imputing hospitalization costs from other European countries leads to TAVR being dominant.
  
  
  CONCLUSIONS
  In countries with relatively low health care costs TAVR is not likely to be cost-effective compared to SAVR in patients with intermediate risk for surgery, mainly because of the high cost of the valve compared to the cost of hospitalization. TAVR could be cost-effective in specific subgroups and in countries with higher hospitalization costs.
authors.affiliation: Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: aidaribera@gmail.com.
authors.forename: Aida
authors.initials: A
authors.lastname: Ribera
authors.affiliation: Department of Business, Universitat Autònoma de Barcelona, Spain.
authors.forename: John
authors.initials: J
authors.lastname: Slof
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Spain.
authors.forename: Rut
authors.initials: R
authors.lastname: Andrea
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Falces
authors.affiliation: Cardiology Department, Instituto de Investigación Sanitaria Gregorio Marañón, Departamento de Medicina, Universidad Complutense, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gutiérrez
authors.affiliation: Unidad de Hemodinamica y Cardiología Intervencionista, Area del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Del Valle-Fernández
authors.affiliation: Unidad de Hemodinamica y Cardiología Intervencionista, Area del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Morís-de la Tassa
authors.affiliation: Servicio de Cardiología, ICICOR, Hospital Clínico Universitario, Valladolid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Mota
authors.affiliation: Servicio de Cardiología, Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Oteo
authors.affiliation: Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Purificació
authors.initials: P
authors.lastname: Cascant
authors.affiliation: Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Omar Abdul-Jawad
authors.initials: OA
authors.lastname: Altisent
authors.affiliation: Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sureda
authors.affiliation: Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Serra
authors.affiliation: Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: García-Del Blanco
authors.affiliation: Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Tornos
authors.affiliation: Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Garcia-Dorado
authors.affiliation: Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-González
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000191:economics / Q000379:methods; D017721:Hospital Costs / Q000639:trends*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000191:economics / Q000379:methods*
keywords: Cost-effectiveness; Surgical aortic valve replacement; Transcatheter aortic valve replacement