Economic Implications of Transcatheter Aortic Valve Replacement in Patients at Intermediate Surgical Risk
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Population aging and other factors are propelling healthcare spending on a perpetually increasing trajectory. More than ever, we must carefully assess the economic impact of adopting new medical technologies into clinical practice. Recently, transcatheter aortic valve replacement (TAVR) has emerged as a remarkable advance in the treatment of aortic stenosis. Studies have shown that TAVR in patients with aortic stenosis at extreme and high surgical risk provides good economic, as well as, clinical value.1–3 As the role of TAVR is now considered for intermediate-risk patients, questions about value must be asked and answered again.
To understand the cost-effectiveness of TAVR in intermediate-risk patients, it is helpful to consider the lessons learned in higher-risk patients. First, it is apparent that the major offsets for the increased technology cost of TAVR in comparison with surgical aortic valve replacement (SAVR) are decreased hospital length of stay (LOS) and a reduced need for postacute rehabilitation services. With TAVR prices currently in excess of $30 000 per device in the United States (in comparison with ≈$5000 per surgical valve), reductions in LOS must be quite large for TAVR to pay for itself. If the costs of TAVR are higher than SAVR, the cost-effectiveness of TAVR from a societal perspective is strongly affected by the presence or absence of a mortality benefit with TAVR. In the absence of a survival difference, the advantages of TAVR …