Nilsson Konrad, James Stefan, Angerås Oskar, Backes Jenny, Bjursten Henrik, Candolfi Pascal, Götberg Mattias, Hagström Henrik, Malmberg Chiara, Nielsen Niels Erik, Sarmah Archita, Settergren Magnus, Bromilow Tom
Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
Ups J Med Sci. 2024 Nov 7;129. doi: 10.48101/ujms.v129.10741. eCollection 2024.
Transcatheter aortic valve implantation (TAVI) has shown similar or improved clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis at low risk for surgical mortality. This cost-utility analysis compared TAVI with SAPIEN 3 versus SAVR in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of the Swedish healthcare system.
A published, two-stage, Markov-based cost-utility model that captured clinical outcomes from the (SWEDEHEART) registry (2018-2020) was adapted from the perspective of the Swedish healthcare system using local general population mortality, utility and costs data. The model had a lifetime horizon. Model outputs included changes in direct healthcare costs and health-related quality of life from using TAVI as compared with SAVR.
TAVI with SAPIEN 3 resulted in lifetime costs per patient of 940,541 Swedish krona (SEK) and lifetime quality-adjusted life years (QALYs) per patient of 7.16, whilst SAVR resulted in lifetime costs and QALYs per patient of 821,380 SEK and 6.81 QALYs, respectively. Compared with SAVR, TAVI offered an incremental improvement of +0.35 QALY per patient at an increased cost of +119,161 SEK per patient over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of 343,918 SEK per QALY gained.
TAVI with SAPIEN 3 is a cost-effective option versus SAVR for patients with symptomatic severe aortic stenosis at low risk for surgical mortality treated in the Swedish healthcare setting. These findings may inform policy decisions in Sweden for the management of this patient group.
对于手术死亡风险较低的有症状重度主动脉瓣狭窄患者，经导管主动脉瓣植入术（TAVI）与外科主动脉瓣置换术（SAVR）相比，已显示出相似或更好的临床结局。本成本效益分析从瑞典医疗保健系统的角度，比较了有症状重度主动脉瓣狭窄且手术死亡风险较低的患者使用TAVI（使用SAPIEN 3瓣膜）与SAVR的情况。
采用已发表的基于马尔可夫模型的两阶段成本效益模型，该模型从瑞典医疗保健系统的角度，利用当地普通人群的死亡率、效用和成本数据，捕捉了瑞典心脏注册研究（SWEDEHEART，2018 - 2020年）中的临床结局。该模型的时间范围为终身。模型输出包括与SAVR相比，使用TAVI导致的直接医疗成本变化和与健康相关的生活质量变化。
使用SAPIEN 3瓣膜的TAVI使每位患者的终身成本为940,541瑞典克朗（SEK），每位患者的终身质量调整生命年（QALY）为7.16；而SAVR使每位患者的终身成本和QALY分别为821,380瑞典克朗和6.81 QALY。与SAVR相比，在终身时间范围内，TAVI使每位患者的QALY增加了0.35，但每位患者的成本增加了119,161瑞典克朗，导致每获得一个QALY的增量成本效益比为343,918瑞典克朗。
在瑞典医疗环境中，对于手术死亡风险较低的有症状重度主动脉瓣狭窄患者，使用SAPIEN 3瓣膜的TAVI相对于SAVR是一种具有成本效益的选择。这些发现可能为瑞典针对该患者群体的管理政策决策提供参考。
