Cost Effectiveness of Transcatheter Aortic Valve Replacement Compared with Standard Care Among Inoperable Patients with Severe Aortic Stenosis: Results from The PARTNER Trial (Cohort B)
Background—In patients with severe aortic stenosis who cannot have surgery, transcatheter aortic valve replacement (TAVR) has been shown to improve survival and quality of life compared with standard therapy, but the costs and cost-effectiveness of this strategy are not yet known.
Methods and Results—The PARTNER trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgery to TAVR (N=179) or standard therapy (N=179). Empirical data regarding survival, quality of life, medical resource use, and hospital costs were collected during the trial and used to project life expectancy, quality-adjusted life expectancy, and lifetime medical care costs in order to estimate the incremental cost-effectiveness of TAVR from a US perspective. For patients treated with TAVR, mean costs for the initial procedure and hospitalization were $42,806 and $78,542, respectively. Follow-up costs through 12 months were lower with TAVR ($29,289 vs. $53,621) due to reduced hospitalization rates, but cumulative 1-year costs remained higher ($106,076 vs. $53,621). We projected that over a patient's lifetime, TAVR would increase discounted life expectancy by 1.6 years (1.3 QALYs) at an incremental cost of $79,837. The incremental cost-effectiveness ratio for TAVR was thus estimated at $50,200 per year of life gained or $61,889 per QALY gained. These results were stable across a broad range of uncertainty and sensitivity analyses.
Conclusions—For patients with severe aortic stenosis who are not candidates for surgery, TAVR increases life expectancy at an incremental cost per life year gained well within accepted values for commonly used cardiovascular technologies.
Clinical Trials Registration Information—ClinicalTrals.gov; NCT00530894
- Received July 4, 2011.
- Accepted January 4, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited