Manolis Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
Ann Cardiothorac Surg. 2017 Sep;6(5):516-523. doi: 10.21037/acs.2017.07.02.
Transcatheter aortic valve implantation (TAVI), an established treatment for inoperable and high-risk operable symptomatic patients with severe aortic stenosis with growing numbers of procedures and expanding indications, is an expensive therapy. Cost-effectiveness analyses rely on the value of the incremental cost-effectiveness ratio (ICER), which is the difference in cost between two possible interventions, divided by the difference in their effect. Several analyses have demonstrated that TAVI is cost-effective with an acceptable ICER for the inoperable patient alone and only via the iliofemoral route, while TAVI is more costly and is either less or equally effective as surgery in high-risk operable patients. When use of TAVI is extended to include a larger number of patients suitable for surgery, the overall results become less favorable. Acceptable ICERs should practically equate to the value of the gross domestic product (GDP) per capita in each country; however, the cost of the TAVI kit alone already exceeds the GDP per capita of all moderate- and low-income countries. An overview of the current cost-efficacy issues of TAVI is presented and this grisly reality is discussed, which may hopefully be improved in the future.
经导管主动脉瓣植入术（TAVI）是一种针对无法进行手术以及手术风险高的有症状重度主动脉瓣狭窄患者的既定治疗方法，随着手术数量的增加和适应症的扩大，它是一种昂贵的治疗手段。成本效益分析依赖于增量成本效益比（ICER）的值，该值是两种可能干预措施之间的成本差异除以它们效果的差异。多项分析表明，仅对于无法进行手术的患者而言，且仅通过髂股途径进行TAVI时，其成本效益是可以接受的，ICER在可接受范围内；而在高风险可手术患者中，TAVI成本更高，与手术相比效果要么较差要么相当。当TAVI的使用范围扩大到包括更多适合手术的患者时，总体结果就不那么乐观了。可接受的ICER实际上应等同于每个国家的人均国内生产总值（GDP）；然而，仅TAVI器械套件的成本就已经超过了所有中低收入国家的人均GDP。本文概述了TAVI当前的成本效益问题，并探讨了这一严峻现实，希望未来情况能有所改善。
