Zhang Weicong, Lou Yake, Liu Yujiang, Wang Hongwei, Zhang Chun, Qian Linxue
Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Cardiovasc Med. 2022 May 26;9:896062. doi: 10.3389/fcvm.2022.896062. eCollection 2022.
Aortic stenosis (AS) is a severe disease that causes heart failure and sudden death. Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are both recommended for patients with intermediate surgical risk, but the cost-effectiveness of TAVR compared to SAVR in China has not been investigated.
A combined decision tree and Markov model were conducted to compare the cost-effectiveness of TAVR versus SAVR with a 5-year simulation. The primary outcome was the incremental cost-effectiveness ratio (ICER), a ratio of incremental costs to incremental quality-adjusted life-year (QALY). One-way sensitive analysis and probabilistic sensitivity analysis (PSA) were conducted to test the robustness of the model.
After a simulation of 5 years, the costs of TAVR and SAVR were 54,573 and 35,002 USD, respectively, and the corresponding effectiveness was 2.826 versus 2.712 QALY, respectively. The ICER for the TAVR versus SAVR comparison was 170,056 USD/QALY, which was three times higher than the per capita gross domestic product (GDP) in China. One-way sensitive analysis showed that the cost of the TAVR device impacted the ICER. The TAVR could be cost-effective only in the case where its cost is lowered to 29,766 USD.
TAVR is currently not cost-effective in China, but it could be cost-effective with a reduction of costs to 29,766 USD, which is approximately 65% of the current price.
主动脉瓣狭窄（AS）是一种导致心力衰竭和猝死的严重疾病。经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）均被推荐用于具有中等手术风险的患者，但在中国，TAVR与SAVR相比的成本效益尚未得到研究。
采用联合决策树和马尔可夫模型，通过5年模拟比较TAVR与SAVR的成本效益。主要结局是增量成本效益比（ICER），即增量成本与增量质量调整生命年（QALY）的比值。进行单向敏感性分析和概率敏感性分析（PSA）以检验模型的稳健性。
经过5年模拟，TAVR和SAVR的成本分别为54,573美元和35,002美元，相应的有效性分别为2.826 QALY和2.712 QALY。TAVR与SAVR比较的ICER为170,056美元/QALY，比中国的人均国内生产总值（GDP）高出三倍。单向敏感性分析表明，TAVR装置的成本影响ICER。只有在其成本降至29,766美元的情况下，TAVR才可能具有成本效益。
目前TAVR在中国不具有成本效益，但如果成本降至29,766美元，即当前价格的约65%，则可能具有成本效益。
