Tarride Jean-Eric, Luong Trinh, Goodall Gordon, Burke Natasha, Blackhouse Gordon
McMaster Chair in Health Technology Management, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton ON, Canada.
Clinicoecon Outcomes Res. 2019 Jul 29;11:477-486. doi: 10.2147/CEOR.S208107. eCollection 2019.
The treatment of severe aortic stenosis requires replacement of the defective native valve. Traditionally, this has been done via surgery, but in the last 10 years, transcatheter techniques have emerged. Transcatheter aortic valve implantation (TAVI) is a less invasive option compared to surgical aortic valve replacement (SAVR), and this study evaluates the cost-effectiveness of TAVI versus SAVR in intermediate and high surgical risk patients in Canada. A Markov model was used to project the costs and quality-adjusted life years (QALYs) gained for TAVI using the SAPIEN 3 valve and SAVR over a 15-year time horizon. The PARTNER I and II studies were used to populate the model in terms of survival, clinical event rates and quality of life over time. The costs of TAVI with SAPIEN 3 and SAVR as well as the costs associated with events included in the model were derived from Canadian administrative and literature data. Costs were expressed in 2018 Canadian dollars and all future costs and QALYs were discounted at a rate of 1.5% annually. Probabilistic and one-way sensitivity analyses were conducted. The incremental cost-effectiveness ratios of TAVI using the SAPIEN 3 valve compared to surgery were $28,154 per QALY gained in intermediate risk patients and $17,237 per QALY gained in high-risk patients. The results of the probabilistic analyses indicated that at willingness-to-pay threshold of $50,000 per QALY gained, the probability of TAVI to be cost-effective was greater than 0.9 in both intermediate-risk and high-risk patients. Sensitivity analyses showed the results were most sensitive to the time horizon used. TAVI using the SAPIEN 3 valve is highly likely to be cost-effective in Canadian patients with severe aortic stenosis who are at intermediate and high surgical risk.
重度主动脉瓣狭窄的治疗需要置换有缺陷的自身瓣膜。传统上，这是通过手术完成的，但在过去10年中，经导管技术已经出现。与外科主动脉瓣置换术（SAVR）相比，经导管主动脉瓣植入术（TAVI）是一种侵入性较小的选择，本研究评估了TAVI与SAVR在加拿大中、高手术风险患者中的成本效益。使用马尔可夫模型预测了使用SAPIEN 3瓣膜的TAVI和SAVR在15年时间范围内获得的成本和质量调整生命年（QALY）。PARTNER I和II研究用于填充模型中随时间变化的生存率、临床事件发生率和生活质量。使用SAPIEN 3的TAVI和SAVR的成本以及模型中包含的事件相关成本来自加拿大行政和文献数据。成本以2018年加拿大元表示，所有未来成本和QALY均按每年1.5%的贴现率贴现。进行了概率分析和单因素敏感性分析。与手术相比，使用SAPIEN 3瓣膜的TAVI在中度风险患者中的增量成本效益比为每获得一个QALY 28,154加元，在高风险患者中为每获得一个QALY 17,237加元。概率分析结果表明，在每获得一个QALY支付意愿阈值为50,000加元时，TAVI具有成本效益的概率在中度风险和高风险患者中均大于0.9。敏感性分析表明，结果对所使用的时间范围最为敏感。对于加拿大中、高手术风险的重度主动脉瓣狭窄患者，使用SAPIEN 3瓣膜的TAVI极有可能具有成本效益。
