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Is Transcatheter Aortic Valve Implantation (TAVI) A Cost-Effective Treatment in Patients Who Are Ineligible For Surgical Aortic Valve Replacement? A Systematic Review of Economic Evaluations.
J Med Econ. 2014 Mar 11;
Authors: Eaton J, Mealing S, Thompson J, Moat N, Kappetein P, Piazza N, Busca R, Osnabrugge R
Abstract
Abstract Objectives Health Technology Assessment (HTA) agencies often undertake a review of economic evaluations of an intervention during an appraisal in order to identify published estimates of cost-effectiveness, to elicit comparisons with the results of their own model, and to support local reimbursement decision making. The aim of this research is to determine whether Transcatheter Aortic Valve Implantation (TAVI) compared to medical management (MM) is cost-effective in patients ineligible for surgical aortic valve replacement (SAVR), across different jurisdictions and country specific evaluations. Methods A systematic review of the literature from 2007 to 2012 was performed in the MEDLINE, MEDLINE in-process, EMBASE and UK NHS EED databases according to standard methods, supplemented by a search of published HTA models. All identified publications were reviewed independently by two health economists. The British Medical Journal (BMJ) 35-point checklist for economic evaluations was used to assess study reporting. To compare results, incremental cost effectiveness ratios (ICERs) were converted to 2012 dollars using purchasing power parity (PPP) techniques. Results Six studies were identified representing five reimbursement jurisdictions (England/Wales, Scotland, USA, Canada, and Belgium) and different modelling techniques. The identified economic evaluations represent different willingness to pay thresholds, discount rates, medical costs and health care systems. In addition the model structures, time horizons and cycle lengths varied. When adjusting for differences in currencies, the ICERs ranged from $27K to $65K per QALY gained. Conclusions Despite notable differences in modelling approach, under the thresholds defined by using either the local threshold value or that recommended by the World Health Organisation WHO threshold value each study showed that TAVI was likely to be a cost-effective intervention for patients ineligible for SAVR.
PMID: 24611813 [PubMed - as supplied by publisher]