Blackman Daniel J, Ryschon Anne M, Barnett Sophie, Garner Abigail M, Forrest John K, Reardon Michael R, Pietzsch Jan B
Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, West Yorkshire, England.
Wing Tech Inc., Menlo Park, CA, USA.
Eur J Health Econ. 2024 Nov 23. doi: 10.1007/s10198-024-01739-2.
The cost-effectiveness of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) has previously been reported across the spectrum of surgical mortality risk. We present an updated analysis specific to the UK based on 4-year data from the Evolut Low Risk Trial, which showed a maintained numerical survival benefit with TAVI.
A decision-analytic Markov model was used to project outcomes and costs over a lifetime horizon. Adverse events and utilities were modeled based on 4-year trial data. Beyond 4 years, no difference in long-term survival between TAVR and SAVR was assumed. Costs were informed by NHS England reference costs and reflect resource utilization in the UK TAVI Trial, with costs and effects discounted at 3.5% p.a. The lifetime incremental cost-effectiveness ratio (ICER) was evaluated against the established £20,000-£ 30,000 per QALY cost-effectiveness threshold. Extensive sensitivity and scenario analyses were performed, including comparison to prior results based on 12-month data.
TAVI improved survival by 0.41 life years and added 0.28 QALYs at incremental cost of £5,021, resulting in a lifetime ICER of £17,883 per QALY gained. 57.5% and 85.3% of probabilistic sensitivity analysis simulations were cost-effective at the £20,000 and £30,000 per QALY thresholds. Use of 4- vs. 1-year trial data markedly improved lifetime cost-effectiveness.
Recent 4-year follow-up data from the Evolut Low Risk trial suggest TAVI adds meaningful patient benefit over lifetime and can be expected to be a cost-effective intervention compared to SAVR for low surgical risk patients in a UK setting.
先前已报告经导管主动脉瓣植入术（TAVI）与外科主动脉瓣置换术（SAVR）在整个手术死亡风险范围内的成本效益。我们基于Evolut低风险试验的4年数据进行了一项针对英国的最新分析，该试验显示TAVI在生存方面有持续的数值优势。
使用决策分析马尔可夫模型预测终身的结局和成本。不良事件和效用基于4年的试验数据进行建模。4年之后，假设TAVR和SAVR在长期生存方面没有差异。成本依据英国国家医疗服务体系（NHS）英格兰参考成本确定，反映了英国TAVI试验中的资源利用情况，成本和效果按每年3.5%进行贴现。根据既定的每质量调整生命年（QALY）20,000 - 30,000英镑的成本效益阈值评估终身增量成本效益比（ICER）。进行了广泛的敏感性和情景分析，包括与基于12个月数据的先前结果进行比较。
TAVI使生存期延长了0.41生命年，增加了0.28个QALY，增量成本为5,021英镑，导致每获得一个QALY的终身ICER为17,883英镑。在每QALY 20,000英镑和30,000英镑的阈值下，57.5%和85.3%的概率敏感性分析模拟具有成本效益。使用4年而非1年的试验数据显著改善了终身成本效益。
Evolut低风险试验最近的4年随访数据表明，TAVI在患者终身中带来了有意义的益处，并且在英国背景下，对于手术风险低的患者而言，与SAVR相比，预计它是一种具有成本效益的干预措施。
