Early cost-utility analysis of tissue-engineered heart valves compared to bioprostheses in the aortic position in elderly patients

Simone A. Huygens (), Isaac Corro Ramos, Carlijn V. C. Bouten, Jolanda Kluin, Shih Ting Chiu, Gary L. Grunkemeier, Johanna J. M. Takkenberg and Maureen P. M. H. Rutten- van Mölken
Additional contact information
Simone A. Huygens: University Medical Center
Isaac Corro Ramos: Erasmus University
Carlijn V. C. Bouten: Eindhoven University of Technology
Jolanda Kluin: Academic Medical Centre
Shih Ting Chiu: Providence Health and Service
Gary L. Grunkemeier: Providence Health and Service
Johanna J. M. Takkenberg: University Medical Center
Maureen P. M. H. Rutten- van Mölken: Erasmus University

The European Journal of Health Economics, 2020, vol. 21, issue 4, No 7, 557-572

Abstract: Abstract Objectives Aortic valve disease is the most frequent indication for heart valve replacement with the highest prevalence in elderly. Tissue-engineered heart valves (TEHV) are foreseen to have important advantages over currently used bioprosthetic heart valve substitutes, most importantly reducing valve degeneration with subsequent reduction of re-intervention. We performed early Health Technology Assessment of hypothetical TEHV in elderly patients (≥ 70 years) requiring surgical (SAVR) or transcatheter aortic valve implantation (TAVI) to assess the potential of TEHV and to inform future development decisions. Methods Using a patient-level simulation model, the potential cost-effectiveness of TEHV compared with bioprostheses was predicted from a societal perspective. Anticipated, but currently hypothetical improvements in performance of TEHV, divided in durability, thrombogenicity, and infection resistance, were explored in scenario analyses to estimate quality-adjusted life-year (QALY) gain, cost reduction, headroom, and budget impact. Results Durability of TEHV had the highest impact on QALY gain and costs, followed by infection resistance. Improved TEHV performance (− 50% prosthetic valve-related events) resulted in lifetime QALY gains of 0.131 and 0.043, lifetime cost reductions of €639 and €368, translating to headrooms of €3255 and €2498 per hypothetical TEHV compared to SAVR and TAVI, respectively. National savings in the first decade after implementation varied between €2.8 and €11.2 million (SAVR) and €3.2–€12.8 million (TAVI) for TEHV substitution rates of 25–100%. Conclusions Despite the relatively short life expectancy of elderly patients undergoing SAVR/TAVI, hypothetical TEHV are predicted to be cost-effective compared to bioprostheses, commercially viable and result in national cost savings when biomedical engineers succeed in realising improved durability and/or infection resistance of TEHV.

Keywords: Early health technology assessment; Patient-level simulation model; Heart valve implantation; Tissue-engineered heart valves (search for similar items in EconPapers)
JEL-codes: I18 I19 (search for similar items in EconPapers)
Date: 2020
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Citations: View citations in EconPapers (1)

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DOI: 10.1007/s10198-020-01159-y

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