Feature | September 19, 2014

New Study Compares Cost-effectiveness of TAVR With Surgical Valve Replacement in High-risk Patients

Results of U.S. CoreValve High Risk trial Reported at TCT 2014

U.S. CoreValve High Risk trial TCT 2014

September 19, 2014 — According to a new study, transcatheter aortic valve replacement (TAVR) provided meaningful clinical benefits relative to surgical aortic valve replacement (SAVR) in high risk patients with incremental costs considered acceptable from a U.S. perspective. Findings from the cost-effectiveness analysis of the U.S. CoreValve High Risk Trial were reported Sept. 13 at the 2014 Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium.

Previous studies have shown that among patients with severe aortic stenosis who are unsuitable for conventional aortic valve surgery, TAVR provides substantial clinical benefits at a reasonable incremental cost. However, there has previously been less consensus about the cost effectiveness of TAVR relative to SAVR for high-risk surgical candidates.

Findings from the U.S. CoreValve High Risk trial, published earlier this year in the New England Journal of Medicine, found that in patients with severe, symptomatic aortic stenosis who were deemed to be at high operative risk, TAVR using a self-expanding prosthesis was associated with lower 12-month mortality compared with SAVR (14.2 percent vs. 19.1 percent).

The cost-effectiveness analysis of the U.S. CoreValve High Risk Trial compared the costs of TAVR and SAVR for this high risk population from the perspective of the US healthcare system. To assess cost effectiveness, inpatient and outpatient medical resource utilization was collected for all patients. Hospital bills were collected for 80 percent of the index hospital admissions and health state utilities were measured using the EQ-5D questionnaire at one, six and 12 months. The primary effectiveness measure was quality adjusted life years (QALY) and the secondary effectiveness measure was life years (LY).

In the as-treated population (n=747), the mean cost for the initial valve implant procedure was $23,661 higher per patient with TAVR than with SAVR ($37,920 vs. $14,258, respectively p<0.001). TAVR reduced the initial hospital length of study by 4.4 days relative to SAVR (8.1 vs. 12.5 days p<0.001) and reduced the need for rehabilitation services at discharge (23 percent vs. 44 percent, respectively p<0.001). Despite this, initial hospital costs were higher with TAVR ($69,000 vs. $58,000, including physician fees) and projected lifetime costs were also higher by approximately $13,700 per patient.

TAVR patients reported significantly better quality of life than SAVR patients at one month, but not at six or 12 months. In lifetime projections, TAVR patients were estimated to gain 0.24 life years and 0.20 quality adjusted life years relative to SAVR patients.

Projected lifetime incremental cost-effectiveness ratios for TAVR were approximately $67,000 per QALY gained and $57,000 LY gained. Results were slightly better among patients suitable for iliofemoral access (n=623) at approximately $55,500 per QALY gained and $48,300 per LY gained. Sensitivity analysis indicated that a reduction in the cost of initial TAVR hospitalizations of approximately $2,000-4,000 per patient would lower the cost effectiveness ratios to less than $50,000 per QALY or LY.

“In this high risk population, TAVR provided meaningful clinical benefits relative to SAVR, with acceptable incremental costs in the U.S.,” said lead investigator Matthew R. Reynolds, M.D., MSc. Reynolds is director, economics and quality of life research at the Harvard Clinical Research Institute.

“With modest reductions in the cost of index TAVR admissions, the value of TAVR compared with SAVR in this patient population would become high.” 

The U.S. CoreValve High Risk trial was funded by Medtronic. Reynolds reported receiving grant and research support from Medtronic and Edwards Lifesciences. He also received honoraria from Medtronic.

For more information: www.crf.org, www.tctconference.com


Related Content

News | Heart Valve Technology

January 4, 2024 — Findings from a published case series research letter by the Henry Ford Health Structural Heart ...

Home January 04, 2024
Home
News | Heart Valve Technology

December 22, 2023 — TRiCares SAS (“TRiCares”), a privately held pioneer in the field of minimally invasive treatment of ...

Home December 22, 2023
Home
News | Heart Valve Technology

December 18, 2023 — Death rates related to infective endocarditis declined in most adults across the U.S. within the ...

Home December 18, 2023
Home
News | Heart Valve Technology

December 12, 2023 — Patients who received the anticoagulant drug warfarin after bioprosthetic aortic valve replacement ...

Home December 12, 2023
Home
News | Heart Valve Technology

November 20, 2023 — Abbott announced new late-breaking data that show advanced heart failure patients living with its ...

Home November 20, 2023
Home
News | Heart Valve Technology

October 24, 2023 — Abiomed, part of Johnson & Johnson MedTech[1], announced that novel data from seven research studies ...

Home October 24, 2023
Home
News | Heart Valve Technology

October 17, 2023 — The Patel Children's Heart Institute at St. Joseph's Children's Hospital achieved a milestone ...

Home October 17, 2023
Home
News | Heart Valve Technology

August 2, 2023 — Foldax, Inc., a leader in the development of innovative, polymer heart valves, today announced that the ...

Home August 02, 2023
Home
News | Heart Valve Technology

July 31, 2023 — Today, the U.S. Food and Drug Administration (FDA) is providing an update to the February 27, 2023 ...

Home July 31, 2023
Home
Subscribe Now