title: Systematic review of model-based economic evaluations of heart valve implantations.
abstract: OBJECTIVE
  To review the evidence on the cost-effectiveness of heart valve implantations generated by decision analytic models and to assess their methodological quality.
  
  
  METHODS
  A systematic review was performed including model-based cost-effectiveness analyses of heart valve implantations. Study and model characteristics and cost-effectiveness results were extracted and the methodological quality was assessed using the Philips checklist.
  
  
  RESULTS
  Fourteen decision-analytic models regarding the cost-effectiveness of heart valve implantations were identified. In most studies transcatheter aortic valve implantation (TAVI) was cost-effective compared to standard treatment (ST) in inoperable or high-risk operable patients (ICER range 18,421-120,779 €) and in all studies surgical aortic valve replacement (SAVR) was cost-effective compared to ST in operable patients (ICER range 14,108-40,944 €), but the results were not consistent on the cost-effectiveness of TAVI versus SAVR in high-risk operable patients (ICER range: dominant to dominated by SAVR). Mechanical mitral valve replacement (MVR) had the lowest costs per success compared to mitral valve repair and biological MVR. The methodological quality of the studies was moderate to good.
  
  
  CONCLUSIONS
  This review showed that improvements can be made in the description and justification of methods and data sources, sensitivity analysis on extrapolation of results, subgroup analyses, consideration of methodological and structural uncertainty, and consistency (i.e. validity) of the models. There are several opportunities for future decision-analytic models of the cost-effectiveness of heart valve implantations: considering heart valve implantations in other valve positions besides the aortic valve, using a societal perspective, and developing patient-simulation models to investigate the impact of patient characteristics on outcomes.
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. s.huygens@erasmusmc.nl.|Department of Health Policy and Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Bayle Building, Campus Woudestein, PO Box 1738, 3000 DR, Rotterdam, The Netherlands. s.huygens@erasmusmc.nl.
authors.forename: Simone A
authors.initials: SA
authors.lastname: Huygens
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Johanna J M
authors.initials: JJM
authors.lastname: Takkenberg
authors.affiliation: Department of Health Policy and Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Bayle Building, Campus Woudestein, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
authors.forename: Maureen P M H
authors.initials: MPMH
authors.lastname: Rutten-van Mölken
mesh_terms: D001024:Aortic Valve Stenosis / Q000628:therapy*; D003362:Cost-Benefit Analysis; D019918:Heart Valve Prosthesis Implantation / Q000191:economics*; D006351:Heart Valves; D006801:Humans; D018803:Models, Economic; D018570:Risk Assessment
keywords: Decision-analytic model; Economic evaluation; Heart valve implantations; Systematic review