کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5967398 | 1576170 | 2015 | 8 صفحه PDF | دانلود رایگان |
![عکس صفحه اول مقاله: Transfemoral transcatheter aortic valve replacement compared with surgical replacement in patients with severe aortic stenosis and comparable risk: Cost-utility and its determinants Transfemoral transcatheter aortic valve replacement compared with surgical replacement in patients with severe aortic stenosis and comparable risk: Cost-utility and its determinants](/preview/png/5967398.png)
ObjectiveTo evaluate cost-effectiveness of transfemoral TAVR vs surgical replacement (SAVR) and its determinants in patients with severe symptomatic aortic stenosis and comparable risk.MethodsPatients 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.ResultsWe 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 â¬8800 higher than SAVR and the gain in QALY was 0.036. The ICER was â¬148,525/QALY. The cost of MC-TAVR was â¬9729 higher than SAVR and the QALY difference was â 0.011 (dominated). Results substantially changed in the following conditions: 1) in patients with high preoperative serum creatinine the ICERs were â¬18,302/QALY and â¬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 â¬32,955/QALY; and 3) imputing hospitalization costs from other European countries leads to TAVR being dominant.ConclusionsIn 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.
Journal: International Journal of Cardiology - Volume 182, 1 March 2015, Pages 321-328