Permsuwan Unchalee, Yoodee Voratima, Buddhari Wacin, Wongpraparut Nattawut, Thonghong Tasalak, Cheewatanakornkul Sirichai, Meemook Krissada, Sakiyalak Pranya, Duangpakdee Pongsanae, Yadee Jirawit
Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
Clinicoecon Outcomes Res. 2022 Jul 23;14:487-498. doi: 10.2147/CEOR.S371417. eCollection 2022.
Transcatheter aortic valve implantation (TAVI) has been shown to be effective in treating patients with severe symptomatic AS who are high-risk population for conventional surgical aortic valve replacement (SAVR). This study aimed to evaluate the cost-utility of TAVI compared with SAVR for severe aortic stenosis with high surgical risk in Thailand.
Lifetime costs and quality-adjusted life years (QALYs) from societal and healthcare perspectives were estimated using a two-part constructed model. The study population consisted of 80-year-old severe AS patients with high surgical risk. Mortality and complication rates were obtained from landmark trials. All cost-related and utility data were based on Thai population. Costs and QALYs were discounted at a rate of 3% annually and presented as 2021 values. Incremental cost-effectiveness ratios (ICERs) were computed. Sensitivity analyses were performed both deterministically and probabilistically.
The findings from a societal perspective revealed that TAVI treatment was associated with higher cost (THB 1,551,895 [USD 47,371.64] vs THB 548,438 [USD 16,741.09] and higher QALYs than SAVR treatment (3.15 vs 2.31 QALYs). The estimated ICER was THB 1,196,191/QALY (USD 36,513.78 QALY). For the healthcare system perspective, TAVI treatment resulted in a higher total cost than SAVR treatment (THB 1,451,317 [USD 44,301.49] vs THB 432,398 [USD 13,198.95]) with comparable gains in LY and QALYs from a societal perspective. The ICER was calculated to be THB 1,214,624/QALY (USD 37,076.42/QALY). TAVI was not cost-effective at the Thai willingness to pay (WTP) threshold of THB 160,000/QALY (USD 4884/QALY). The model was the most sensitive to changes in TAVI valve cost and TAVI or SAVR treatment utilities.
TAVI is not a cost-effective strategy in patients with severe AS who are at high surgical risk when compared to SAVR at the WTP of THB 160,000/QALY (USD 4884/QALY) from the perspectives of society and the healthcare system.
经导管主动脉瓣植入术（TAVI）已被证明在治疗严重症状性主动脉瓣狭窄（AS）患者方面是有效的，这些患者是传统外科主动脉瓣置换术（SAVR）的高危人群。本研究旨在评估在泰国，TAVI与SAVR治疗具有高手术风险的严重主动脉瓣狭窄的成本效益。
使用两部分构建模型从社会和医疗保健角度估计终身成本和质量调整生命年（QALY）。研究人群包括80岁的高手术风险严重AS患者。死亡率和并发症发生率来自标志性试验。所有与成本相关和效用数据均基于泰国人群。成本和QALY按每年3%的贴现率贴现，并以2021年的价值呈现。计算增量成本效益比（ICER）。进行了确定性和概率性敏感性分析。
从社会角度的研究结果显示，TAVI治疗的成本更高（1,551,895泰铢[47,371.64美元]对548,438泰铢[16,741.09美元]），且QALY高于SAVR治疗（3.15对2.31个QALY）。估计的ICER为1,196,191泰铢/QALY（36,513.78美元/QALY）。从医疗保健系统角度来看，TAVI治疗导致的总成本高于SAVR治疗（1,451,317泰铢[44,301.49美元]对432,398泰铢[13,198.95美元]），从社会角度来看，LY和QALY的收益相当。计算出的ICER为1,214,624泰铢/QALY（37,076.42美元/QALY）。在泰国每QALY支付意愿（WTP）阈值为16万泰铢（4884美元/QALY）时，TAVI不具有成本效益。该模型对TAVI瓣膜成本以及TAVI或SAVR治疗效用的变化最为敏感。
从社会和医疗保健系统角度来看，与SAVR相比，在每QALY支付意愿为16万泰铢（4884美元/QALY）时，TAVI对于具有高手术风险的严重AS患者不是一种具有成本效益的策略。
