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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)

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Objectives

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. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894)

Key Words

aortic valve replacement
cost-effectiveness
TAVR

Abbreviations and Acronyms

AS
aortic stenosis
AVR
aortic valve replacement
EQ-5D
EuroQol
ICER
incremental cost-effectiveness ratio
mITT
modified intention-to-treat
QOL
quality of life
TA
transapical
TAVR
transcatheter aortic valve replacement
TF
transfemoral

Cited by (0)

Supported by Edwards Lifesciences, Inc. Dr. Reynolds receives research grant support from Edwards Lifesciences; and is a consultant for Medtronic. Dr. Pinto is a consultant to Medtronic, Inc. Dr. Thourani is a member of the Advisory Boards of Edwards Lifesciences, Sorin Medical, and St. Jude Medical; and receives research grant support from Edwards Lifesciences. Drs. Svensson and Leon have received travel reimbursements from Edwards Lifesciences related to their participation as members of the Executive Committee of the PARTNER Trial. Dr. Miller is a consultant to Edwards Lifesciences Inc.; and has received research grant support from Medtronic, Abbott Vascular, and a grant from the National Institutes of Health (grant HL67025), and from the GenTAC Scientific Advisory Oversight Board. Dr. Satler has received research grants from Edwards Lifesciences. Dr. Cohen has received research grants from Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, AstraZeneca, and Eli Lilly; is a consultant for Medtronic and Abbott Vascular; and has received speaking honoraria from Eli Lilly. Dr. Bavaria is a principal investigator for Edwards. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.