Cost Utility of Transcatheter Aortic Valve Replacement: Sapien 3 Versus CoreValve Evolut R. Issue 5 (22nd January 2023)

• Record Type: Journal Article
• Authors: Posawatz, David; Bloom, Joshua; Massed, Alison; Chatterjee, Abhishek; Resor, Charles; Zhan, Yong; Weintraub, Andrew; Kawabori, Masashi
• Is Part Of: ASAIO journal. Volume 69:Issue 5(2023)
• Page Start: 475
• Page End: 482
• Publication Date: 2023-01-22
• Subjects: cost-utility -- transcatheter aortic valve replacement -- TAVR -- aortic stenosis -- QALY; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000001864
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis. Previous studies compare clinical outcomes of leading TAVR valves, but there is no evidence of cost-utility comparison, leaving a clinical information gap when selecting valves. Here we share a cost-utility analysis comparing the Sapien 3 (S3) (Edwards Lifesciences, Irvine, CA) and CoreValve Evolut R (ER) (Medtronic, Dublin, IR) across five clinical endpoints. Utility scores from patient surveys and clinical outcomes from the literature were used to estimate quality-adjusted life years (QALYs) associated with successful procedure and postoperative complications for S3 and ER. A decision tree was constructed with rollback analysis to highlight the more cost-effective strategy. An incremental cost-utility ratio (ICUR) analysis was performed with a willingness to pay at $50, 000. Deterministic and probabilistic sensitivity analyses were performed to validate robustness of results and account for uncertainty. S3 was found to be more costly ($68, 377 vs. $66, 072), but more effective (1.87 vs . 1.66) compared with ER. An ICUR of 11, 288.12 favored S3, making it the more cost-effective option with a moderate confidence of 73.68% in Monte Carlo analysis. Cost-utility analysis can be used to aid in healthcare economics decision-making when selecting between comparable technologies used for TAVR procedures.