Transcatheter aortic valve implantation against conventional aortic valve replacement surgery in high-risk patients with aortic stenosis; a cost-effectiveness analysis

Hesam Ghiasvand (), Shiva Khaleghparast (), Naser Kachoueian (), Kourosh Tirgarfakheri (), Meysam Mortazian (), Yaser Toloueitabar (), Farhad Gorjipour () and Seyran Naghdi ()
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Hesam Ghiasvand: University of Warwick
Shiva Khaleghparast: Iran University of Medical Sciences
Naser Kachoueian: Shahid Beheshti University of Medical Sciences
Kourosh Tirgarfakheri: Iran University of Medical Sciences
Meysam Mortazian: AJA University of Medical Sciences Tehran Iran AJA University of Medical Sciences
Yaser Toloueitabar: Iran University of Medical Sciences
Farhad Gorjipour: Iran University of Medical Sciences
Seyran Naghdi: National Center for Health Insurance Research

Health Economics Review, 2023, vol. 13, issue 1, 1-9

Abstract: Abstract Background Aortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in financial resources, it is crucial to investigate the cost-effectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-effectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery. Methods This study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran’s national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty. Results The incremental cost, effectiveness, and cost-effectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$ 1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-effective at one and three times the country’s Gross Domestic Production (GDP) is 0.31 and 0.83, respectively. Conclusions TAVI does not seem a cost-effective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-effective will raise to 83%.

Keywords: Aortic stenosis; Transcatheter Aortic Valve Implantation (TAVI); Surgical Aortic Valve Replacement; Cost-effectiveness analysis; Economic evaluation (search for similar items in EconPapers)
Date: 2023
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DOI: 10.1186/s13561-022-00411-w

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