Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China.
Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
BMJ Open. 2024 Nov 18;14(11):e082283. doi: 10.1136/bmjopen-2023-082283.
Examine the cost-effectiveness of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) for Chinese patients with severe aortic stenosis (AS) at intermediate and high surgical risk.
A two-phase model, comprising a 1-month decision tree to simulate perioperative outcomes and a 5-year Markov model with monthly cycles to simulate long-term outcomes, has been developed to evaluate the cost-effectiveness of TAVI compared with SAVR for Chinese patients with AS at intermediate and high risk. The event rates for both phases are sourced from the Placement of Aortic Transcatheter Valves IA and IIA trials, while the cost inputs and utility values are sourced from local sources or published literature. Adjustments for inflation were made using consumer price indexes for healthcare to enhance precision. To ensure the reliability and robustness of the model, sensitivity analyses were conducted to assess their impact on outcomes.
China healthcare system perspective.
A hypothetical cohort of Chinese patients with AS in intermediate and high surgical risk.
TAVI versus SAVR.
Cost, quality-adjusted life-years (QALYs), life-years gained and incremental cost-effectiveness Ratio (ICER).
For both intermediate- and high-risk AS patients, offering TAVR resulted in high healthcare costs but moderate benefits compared with SAVR. Specifically, in the intermediate-risk population, TAVR led to a 0.34 QALY increase over SAVR, with an incremental cost of $16 707.58, resulting in an ICER of $49 176.60/QALY. Similarly, in the high-risk population, TAVR showed a 0.15 QALY increase over SAVR, with an incremental cost of $18 093.52, leading to an ICER of $122 696.37/QALY. However, both ICERs exceeded the willingness-to-pay threshold of $37 654.50/QALY. Sensitivity analyses confirmed the model's stability under parameter uncertainty.
TAVI was deemed not cost-effective compared with SAVR for patients with AS at intermediate or high surgical risk in the Chinese healthcare system. Lowering valve costs was considered an effective approach to improve the cost-effectiveness of TAVI.
研究经导管主动脉瓣植入术（TAVI）与外科主动脉瓣置换术（SAVR）治疗中国中高危主动脉瓣狭窄（AS）患者的成本效果。
采用两阶段模型，包括 1 个月的决策树模拟围手术期结果和 5 年的每月循环 Markov 模型模拟长期结果，评估 TAVI 与 SAVR 治疗中国中高危 AS 患者的成本效果。两阶段的事件发生率均来自 Placement of Aortic Transcatheter Valves IA 和 IIA 试验，而成本投入和效用值则来自当地来源或已发表的文献。使用医疗保健消费者价格指数对通货膨胀进行调整，以提高精度。为了确保模型的可靠性和稳健性，进行了敏感性分析以评估其对结果的影响。
中国医疗保健系统视角。
中高危外科手术 AS 患者的假设队列。
TAVI 与 SAVR。
对于中高危 AS 患者，与 SAVR 相比，TAVI 会导致较高的医疗保健成本，但收益适中。具体来说，在中危人群中，TAVI 导致与 SAVR 相比 QALY 增加 0.34，增量成本为 16707.58 美元，ICER 为 49176.60/QALY。同样，在高危人群中，TAVI 与 SAVR 相比 QALY 增加 0.15，增量成本为 18093.52 美元，ICER 为 122696.37/QALY。然而，这两个 ICER 都超过了 37654.50 美元/QALY 的意愿支付阈值。敏感性分析证实了模型在参数不确定性下的稳定性。
在中国医疗保健体系中，与 SAVR 相比，TAVI 对于中高危 AS 患者不具有成本效果。降低瓣膜成本被认为是提高 TAVI 成本效果的有效方法。
