The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement

Aida Ribera, John Slof, Ignacio Ferreira-González (), Vicente Serra, Bruno García-del Blanco, Purificació Cascant, Rut Andrea, Carlos Falces, Enrique Gutiérrez, Raquel del Valle-Fernández, César Morís- de laTassa, Pedro Mota, Juan Francisco Oteo, Pilar Tornos and David García-Dorado
Additional contact information
Aida Ribera: University Hospital Vall d’Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
John Slof: Universitat Autònoma de Barcelona
Ignacio Ferreira-González: University Hospital Vall d’Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
Vicente Serra: University Hospital Vall d’Hebron
Bruno García-del Blanco: University of Barcelona
Purificació Cascant: University Hospital Vall d’Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
Rut Andrea: University of Barcelona
Carlos Falces: University of Barcelona
Enrique Gutiérrez: Universidad Complutense
Raquel del Valle-Fernández: Hospital Universitario Central de Asturias
César Morís- de laTassa: Hospital Universitario Central de Asturias
Pedro Mota: Hospital Clínico Universitario
Juan Francisco Oteo: Hospital Puerta de Hierro
Pilar Tornos: University Hospital Vall d’Hebron
David García-Dorado: University Hospital Vall d’Hebron

The European Journal of Health Economics, 2018, vol. 19, issue 7, No 5, 945-956

Abstract: Abstract Objectives The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. Methods This is a cost-utility analysis from the perspective of the Spanish National Health Service. Results of two prospective hospital registries (158 and 273 consecutive patients) were incorporated into a probabilistic Markov model to compare quality adjusted life years (QALYs) and costs for TAVR after waiting for 3–12 months, relative to immediate TAVR. We simulated a cohort of 1000 patients, male, and 80 years old; other patient profiles were assessed in sensitivity analyses. Results As waiting time increased, costs decreased at the expense of lower survival and loss of QALYs, leading to incremental cost-effectiveness ratios for eliminating waiting lists of about 12,500 € per QALY. In subgroup analyses prioritization of patients for whom higher benefit was expected led to a smaller loss of QALYs. Concerning budget impact, long waiting lists reduced spending considerably and permanently. Conclusions A shorter waiting time is likely to be cost-effective (considering commonly accepted willingness-to-pay thresholds in Europe) relative to 3 months or longer waiting periods. If waiting lists are nevertheless seen as unavoidable due to severe but temporary budgetary restrictions, prioritizing patients for whom higher benefit is expected appears to be a way of postponing spending without utterly sacrificing patients’ survival and quality of life.

Keywords: Waiting lists; Cost-utility; Transcatheter aortic valve replacement; Aortic stenosis (search for similar items in EconPapers)
JEL-codes: I I1 I19 (search for similar items in EconPapers)
Date: 2018
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DOI: 10.1007/s10198-017-0941-3

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