School of Pharmacy, Northeastern University, Boston, MA, USA.
Syenza, Anaheim, CA, USA.
J Med Econ. 2022 Jan-Dec;25(1):1149-1157. doi: 10.1080/13696998.2022.2133320.
A budget impact analysis (BIA) comparing bioprosthetic valves with RESILIA tissue and mechanical valves in aortic stenosis (AS) patients > 65 years in the public and private sectors of Saudi Arabia.
A decision-tree with a partitioned survival model was adapted to estimate the financial consequences of either a RESILIA tissue valve or a mechanical valve in aortic valve replacement (AVR) procedures up to 5 years. The budget impact of resource consumption for both valve types was compared and included disabling strokes, reoperations, minor thromboembolic events, major bleeding, endocarditis, anticoagulation treatment and monitoring, and echocardiogram assessments. One-way sensitivity analyses (OWSA) were performed on cost and probability inputs.
RESILIA tissue valves versus mechanical valves are overall budget saving commencing in Year 1 and savings gradually increase year-on-year. The higher costs of the initial procedure, reoperation, and additional monitoring (echocardiogram tests and visits) associated with RESILIA tissue valves are offset by savings in warfarin use, disabling strokes, major bleeding, and anticoagulation complications. The cost per initial procedure per patient is SAR795 higher for a RESILIA tissue valve reflecting the higher valve acquisition cost, which is partially offset by a shorter hospital stay. The OWSA suggests that total procedure costs of each valve, including the hospital stay, are the main cost drivers in the model.
The variability of cost inputs and the presence of multiple payers with multiple costing data is a key challenge in Saudi Arabia. Budget impact results may, therefore, change if repeated per AVR center and may also be impacted by the long-term durability of RESILIA tissue valves.
An AVR in patients > 65 years with a RESILIA tissue valve is budget-saving from the first year in Saudi Arabia. Patients, payers, providers and policymakers may benefit economically from increased implantation of RESILIA tissue valves.
在沙特阿拉伯的公共和私营部门中，对 65 岁以上患有主动脉瓣狭窄（AS）的患者，进行生物瓣与 RESILIA 组织瓣和机械瓣的预算影响分析（BIA）比较。
采用决策树和分割生存模型，估计 RESILIA 组织瓣或机械瓣在主动脉瓣置换（AVR）手术中 5 年内的财务后果。比较两种瓣膜类型的资源消耗预算影响，包括致残性中风、再次手术、小血栓栓塞事件、大出血、心内膜炎、抗凝治疗和监测以及超声心动图评估。对成本和概率输入进行单因素敏感性分析（OWSA）。
RESILIA 组织瓣与机械瓣相比，从第 1 年开始总体上节省预算，并且逐年稳步增加。RESILIA 组织瓣初始手术、再次手术和额外监测（超声心动图检查和就诊）的较高成本，被华法林使用、致残性中风、大出血和抗凝并发症的节省所抵消。RESILIA 组织瓣每位患者初始手术的成本为 795 里亚尔，高于机械瓣，这反映了较高的瓣膜购置成本，而较短的住院时间部分抵消了这一成本。OWSA 表明，每个瓣膜的总手术成本，包括住院费用，是模型中的主要成本驱动因素。
成本输入的可变性和多个支付者存在多个成本数据，是沙特阿拉伯面临的一个关键挑战。因此，如果按照每个 AVR 中心进行重复，预算影响结果可能会发生变化，RESILIA 组织瓣的长期耐久性也可能会对结果产生影响。
在沙特阿拉伯，对 65 岁以上患者进行 AVR，使用 RESILIA 组织瓣从第 1 年开始具有预算节省效果。患者、支付者、提供者和政策制定者可能会从 RESILIA 组织瓣的广泛植入中获得经济效益。
