Ghiasvand Hesam, Khaleghparast Shiva, Kachoueian Naser, Tirgarfakheri Kourosh, Mortazian Meysam, Toloueitabar Yaser, Gorjipour Farhad, Naghdi Seyran
Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Health Econ Rev. 2023 Jan 3;13(1):1. doi: 10.1186/s13561-022-00411-w.
Aortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in financial resources, it is crucial to investigate the cost-effectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-effectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery.
This study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran's national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty.
The incremental cost, effectiveness, and cost-effectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$ 1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-effective at one and three times the country's Gross Domestic Production (GDP) is 0.31 and 0.83, respectively.
TAVI does not seem a cost-effective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-effective will raise to 83%.
主动脉瓣狭窄是伊朗一种常见的心脏瓣膜疾病。经导管主动脉瓣植入术（TAVI）和外科主动脉瓣置换术（SAVR）是当前临床路径中治疗该疾病的两种常见手术。然而，TAVI手术费用高昂，对于财政资源严重受限的伊朗而言，研究该技术相对于其他具有相同目的的竞争替代方案的成本效益至关重要。本研究旨在分析TAVI与SAVR在手术风险较高的老年患者中的成本效益。
本研究是一项决策经济评估模型，采用终身视角和医疗支付方（健康保险公司）视角。效用值来自先前的一项研究，转移概率来自一项名为PARTNER - 1的既定临床试验，单位成本来自伊朗国家医疗服务收费表。进行了概率分析和单向敏感性分析以降低不确定性。
基础病例的增量成本、效果和成本效益比分别为：368,180,101伊朗里亚尔（1,473美元）、每位患者0.37质量调整生命年以及995,081,354伊朗里亚尔（3,980美元）。概率敏感性分析得出每位患者的增量成本效益比为981,765,302伊朗里亚尔（3,927美元）。在该国国内生产总值（GDP）的1倍和3倍时具有成本效益的概率分别为0.31和0.83。
在该国当前的支付意愿阈值下，与SAVR相比，TAVI似乎不是一种具有成本效益的手术。然而，将支付意愿阈值提高到人均GDP的3倍时，具有成本效益的概率将升至83%。
