Harvard Clinical Research Institute, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2012 Dec 25;60(25):2683-92. doi: 10.1016/j.jacc.2012.09.018. Epub 2012 Nov 1.
The aim of this study was to evaluate the cost-effectiveness of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (AVR) for patients with severe aortic stenosis and high surgical risk.
TAVR is an alternative to AVR for patients with severe aortic stenosis and high surgical risk.
We performed a formal economic analysis based on cost, quality of life, and survival data collected in the PARTNER A (Placement of Aortic Transcatheter Valves) trial in which patients with severe aortic stenosis and high surgical risk were randomized to TAVR or AVR. Cumulative 12-month costs (assessed from a U.S. societal perspective) and quality-adjusted life-years (QALYs) were compared separately for the transfemoral (TF) and transapical (TA) cohorts.
Although 12-month costs and QALYs were similar for TAVR and AVR in the overall population, there were important differences when results were stratified by access site. In the TF cohort, total 12-month costs were slightly lower with TAVR and QALYs were slightly higher such that TF-TAVR was economically dominant compared with AVR in the base case and economically attractive (incremental cost-effectiveness ratio <$50,000/QALY) in 70.9% of bootstrap replicates. In the TA cohort, 12-month costs remained substantially higher with TAVR, whereas QALYs tended to be lower such that TA-TAVR was economically dominated by AVR in the base case and economically attractive in only 7.1% of replicates.
In the PARTNER trial, TAVR was an economically attractive strategy compared with AVR for patients suitable for TF access. Future studies are necessary to determine whether improved experience and outcomes with TA-TAVR can improve its cost-effectiveness relative to AVR.
本研究旨在评估经导管主动脉瓣置换术（TAVR）与外科主动脉瓣置换术（AVR）治疗高危重度主动脉瓣狭窄患者的成本效果。
TAVR 是高危重度主动脉瓣狭窄患者的 AVR 替代疗法。
我们基于 PARTNER A 试验（Placement of Aortic Transcatheter Valves）中收集的成本、生活质量和生存数据进行了正式的经济分析，该试验将高危重度主动脉瓣狭窄患者随机分为 TAVR 或 AVR 组。分别比较经股动脉（TF）和经心尖（TA）入路患者的 12 个月累积成本（从美国社会角度评估）和质量调整生命年（QALY）。
虽然 TAVR 和 AVR 在总体人群中的 12 个月成本和 QALY 相似，但按入路分层时结果存在重要差异。在 TF 队列中，TAVR 的 12 个月总成本略低，QALY 略高，因此在基线情况下，TF-TAVR 比 AVR 具有经济性优势，且在 70.9%的bootstrap 复制中具有成本效益（增量成本效益比 <50,000 美元/QALY）。在 TA 队列中，TAVR 的 12 个月成本仍明显较高，而 QALY 往往较低，因此在基线情况下，TA-TAVR 比 AVR 具有经济性劣势，且仅在 7.1%的复制中具有成本效益。
在 PARTNER 试验中，对于适合 TF 入路的患者，TAVR 是一种比 AVR 更具成本效益的策略。未来的研究需要确定 TA-TAVR 的经验和结果改善是否可以提高其相对于 AVR 的成本效益。
