Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia; School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Torrens University Australia, Adelaide, SA, Australia.
Lancet Healthy Longev. 2022 Sep;3(9):e599-e606. doi: 10.1016/S2666-7568(22)00168-4. Epub 2022 Aug 18.
Aortic stenosis is the most common cardiac valve disorder requiring clinical management. However, there is little evidence on the societal cost of progressive aortic stenosis. We sought to quantify the societal burden of premature mortality associated with progressively worse aortic stenosis.
In this observational clinical cohort study, we examined echocardiograms on native aortic valves of 98 565 men and 99 357 women aged 65 years or older across 23 sites in Australia, from Jan 1, 2003, to Dec 31, 2017. Individuals were grouped according to their peak aortic valve velocity in 0·50 m/s increments up to 4·00 m/s or more (severe aortic stenosis), using 1·00-1·99 m/s (no aortic stenosis) as the reference group. Sex-specific premature mortality and years of life lost during a 5-year follow-up were calculated, along with willingness-to-pay to regain quality-adjusted life years (QALYs).
Overall, 20 701 (21·0%) men and 18 576 (18·7%) women had evidence of mild-to-severe aortic stenosis. The actual 5-year mortality in men with normal aortic valves was 32·1% and in women was 26·1%, increasing to 40·9% (mild aortic stenosis) and 52·2% (severe aortic stenosis) in men and to 35·9% (mild aortic stenosis) and 55·3% (severe aortic stenosis) in women. Overall, the estimated societal cost of premature mortality associated with aortic stenosis was AU$629 million in men and $735 million in women. Per 1000 men and women investigated, aortic stenosis was associated with eight more premature deaths in men resulting in 32·5 more QALYs lost (societal cost of $1·40 million) and 12 more premature deaths in women resulting in 57·5 more QALYs lost (societal cost of $2·48 million) when compared with those without aortic stenosis.
Any degree of aortic stenosis in older individuals is associated with premature mortality and QALYs. In this context, there is a crucial need for cost-effective strategies to promptly detect and optimally manage this common condition within our ageing populations.
Edwards LifeSciences, National Health and Medical Research Council of Australia, and the National Heart, Lung, and Blood Institute.
主动脉瓣狭窄是最常见的需要临床管理的心脏瓣膜疾病。然而，关于进展性主动脉瓣狭窄的社会成本证据甚少。我们旨在量化与进展性主动脉瓣狭窄相关的过早死亡给社会带来的负担。
在这项观察性临床队列研究中，我们对 2003 年 1 月 1 日至 2017 年 12 月 31 日期间，在澳大利亚 23 个地点接受过经胸超声心动图检查的 98565 名 65 岁及以上男性和 99357 名 65 岁及以上女性的原生主动脉瓣进行了研究。根据峰值主动脉瓣流速（0.50 m/s 递增至 4.00 m/s 或更高）将个体分为不同组，其中 1.00-1.99 m/s 为无主动脉瓣狭窄组（参考组），4.00 m/s 或更高为严重主动脉瓣狭窄组。计算了 5 年随访期间的男女特定性过早死亡率和生命年损失，并计算了为恢复质量调整生命年（QALY）而愿意支付的费用。
总体而言，20701 名男性（21.0%）和 18576 名女性（18.7%）存在轻至重度主动脉瓣狭窄的证据。男性主动脉瓣正常的实际 5 年死亡率为 32.1%，女性为 26.1%，男性轻度主动脉瓣狭窄组为 40.9%，严重主动脉瓣狭窄组为 52.2%，女性轻度主动脉瓣狭窄组为 35.9%，严重主动脉瓣狭窄组为 55.3%。总体而言，与主动脉瓣狭窄相关的过早死亡给社会带来的成本估计为男性 6.29 亿澳元，女性 7.35 亿澳元。在接受调查的每 1000 名男性和女性中，与无主动脉瓣狭窄的患者相比，男性主动脉瓣狭窄导致 8 例过早死亡，导致 32.5 个 QALY 损失（社会成本为 140 万澳元），女性主动脉瓣狭窄导致 12 例过早死亡，导致 57.5 个 QALY 损失（社会成本为 248 万澳元）。
老年人任何程度的主动脉瓣狭窄都与过早死亡和 QALY 相关。在这种情况下，迫切需要制定具有成本效益的策略，以便在我们不断老龄化的人群中及时发现并最佳管理这种常见疾病。
爱德华兹生命科学公司、澳大利亚国家卫生和医学研究委员会以及美国国家心肺血液研究所。
