Cost-effectiveness of transcatheter aortic valve implantation in patients at low surgical risk in France: a model-based analysis of the Evolut LR trial

Didier Tchétché (), Coline Dubois Gennes, Quentin Cormerais, Benjamin P. Geisler, Camille Dutot, Fanny Wilquin-Bequet, Manon Breau-Brunel, Béranger Lueza and Jan B. Pietzsch
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Didier Tchétché: Clinique Pasteur
Coline Dubois Gennes: Amaris
Quentin Cormerais: Medtronic, Plc
Benjamin P. Geisler: Massachusetts General Hospital, Harvard Medical School
Camille Dutot: Medtronic, Plc
Fanny Wilquin-Bequet: Medtronic, Plc
Manon Breau-Brunel: Amaris
Béranger Lueza: Amaris
Jan B. Pietzsch: Wing Tech Inc.

The European Journal of Health Economics, 2024, vol. 25, issue 3, No 6, 447-457

Abstract: Abstract Background In the recent Evolut Low Risk randomized trial, transcatheter aortic valve implantation (TAVI) was shown to be non-inferior to surgery (SAVR) regarding the composite end point of all-cause mortality or disabling stroke at 24 months. Aims To evaluate the cost-effectiveness of self-expandable TAVI in low-risk patients, using the French healthcare system as the basis for analysis. Methods Mortality, health-related quality of life, and clinical event rates through two-year follow-up were derived from trial data (N = 725 TAVI and N = 678 SAVR; mean age: 73.9 years; mean STS-PROM: 1.9%). Cost inputs were based on real-world data for TAVI and SAVR procedures in the French healthcare system. Costs and effectiveness as quality-adjusted life years (QALYs) were projected to lifetime via a decision-analytic model under assumption of no mortality difference beyond two years. The discounted incremental cost-effectiveness ratio (ICER) was evaluated against a willingness-to-pay threshold of €50,000 per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted, including assumptions about differential long-term survival. Results For the base case, mean survival was 13.69 vs 13.56 (+ 0.13) years for TAVI and SAVR, respectively. Discounted QALYs were 9.34 vs. 9.21 (+ 0.13) and discounted lifetime costs €52,267 vs. €51,433 (+ €833), resulting in a lifetime ICER of €6368 per QALY gained. In probabilistic sensitivity analysis, TAVI was found dominant or cost-effective in 74.4% of samples. Conclusion TAVI in patients at low surgical risk is a cost-effective alternative to SAVR in the French healthcare system. Longer follow-up data will help increase the accuracy of lifetime survival projections. Graphical Abstract

Keywords: Aortic valve stenosis; Transcatheter aortic valve implantation; Surgical aortic valve replacement; Cost–benefit analysis; Health-related quality of life; France (search for similar items in EconPapers)
JEL-codes: H51 I13 I18 (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1007/s10198-023-01590-x

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