Abstract
Background
Transcatheter aortic valve replacement (TAVR) is approved for use across the entire
spectrum of risk, including low-surgical-risk patients for severe aortic stenosis
(AS). TAVR has been shown to be cost-effective compared with surgical aortic valve
replacement (SAVR) in Canada. However, the affordability of implementing TAVR for
low-risk AS patients from the hospital’s payers’ perspective is unknown.
Methods
A budget impact analysis was conducted using a 1-year time horizon to quantify the
total cost of health care resource utilisation to initially treat low-risk AS patients
and manage subsequent adverse events. Differences in cost between TAVR and SAVR were
calculated for 100 patients for various scenarios of TAVR uptake (10% to 70%) in low-risk
AS patients. Event rates and associated costs were obtained from published literature
and provincial datasets. Costs were reported in 2021 Canadian dollars. One-way sensitivity
analysis on key TAVR input parameters was conducted.
Results
Mean index hospitalisation costs of SAVR and TAVR per patient were $41,956 and $37,669,
respectively. The average total costs of managing a low-risk AS patient in 1 year
for TAVR and SAVR were $45,897 and $42,659, respectively. The incremental budget impacts
of increasing TAVR uptake from 10% to 50% and 70% were 3% and 4.5%, respectively.
One-way sensitivity analysis on key variables showed that the main contributors to
the cost difference were the intensive care unit stay, permanent pacemaker rate, and
hospital length of stay.
Conclusions
The incremental annual cost of implementing TAVR in low-risk AS patients was small,
making TAVR likely an affordable strategy.
Résumé
Contexte
Le remplacement valvulaire aortique par cathéter (RVAC) est une stratégie thérapeutique
approuvée, quel que soit le niveau de risque des patients, y compris chez ceux présentant
une sténose aortique (SA) grave et un faible risque opératoire. Au Canada, le RVAC
présente un rapport coût-efficacité avantageux par rapport à celui de la chirurgie
de remplacement valvulaire aortique (CRVA). Néanmoins, on ne sait pas si le recours
au RVAC chez les patients présentant une SA et un faible risque opératoire est économiquement
viable pour les payeurs du secteur hospitalier.
Méthodologie
Une analyse de l’incidence budgétaire a été effectuée pour évaluer le coût annuel
total lié aux ressources de santé utilisées dans le traitement initial des patients
présentant une SA et un faible risque opératoire, ainsi que pour la prise en charge
des manifestations indésirables ultérieures. Les différences de coûts entre le RVAC
et la CRVA ont été calculées pour 100 patients selon diverses proportions de RVAC
(de 10 % à 70 %) chez les patients présentant une SA et un faible risque opératoire.
Les taux d’incidence des manifestations indésirables et les coûts associés ont été
tirés de la littérature scientifique et des bases de données provinciales. Les coûts
ont été exprimés en dollars canadiens selon le cours de 2021. Une analyse de sensibilité
unidirectionnelle a été effectuée pour les principaux paramètres d’entrée du RVAC.
Résultats
Les coûts d’hospitalisation moyens pour la CRVA et le RVAC étaient de 41 956 et de
37 669 dollars, respectivement. Les coûts annuels moyens pour la prise en charge d’un
patient présentant une SA et un faible risque opératoire étaient de 45 897 dollars
pour le RVAC et de 42 659 dollars pour la CRVA. Les valeurs d’incidence budgétaire
différentielle d’une augmentation de la proportion de RVAC de 10 % à 50 % ou à 70
% étaient de 3 % et de 4,5 %, respectivement. Une analyse de sensibilité unidirectionnelle
des facteurs principaux a révélé que les variables contribuant le plus à la différence
de coût étaient les séjours en soins intensifs, le taux d’implantation d’un stimulateur
cardiaque permanent et la durée d’hospitalisation.
Conclusions
Compte tenu des faibles coûts annuels supplémentaires associés à l’instauration du
RVAC chez les patients présentant une SA et un faible risque opératoire, le RVAC est,
selon toute vraisemblance, une stratégie que l’on peut qualifier d’abordable.
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Article info
Publication history
Published online: September 11, 2022
Accepted:
June 3,
2022
Received:
December 24,
2021
Footnotes
See editorial by Chew and Clement, pages 1485-1487 of this issue.
See page 1483 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Open Access Budget Impact Assessment Tools: A Welcome Step in Supporting Evidence-Informed Policy DecisionsCanadian Journal of CardiologyVol. 38Issue 10
- PreviewOver the past several decades, transcatheter aortic valve replacement (TAVR) has emerged as a disruptive technology that transformed the management of patients with severe aortic stenosis. Initially offered to mostly older patients with aortic stenosis who were not surgical candidates because of excessive operative risk, TAVR has become an acceptable therapeutic option for operative candidates who are at high or moderate surgical risk.1,2 More recent randomized studies, such as the landmark Placement of Aortic Transcatheter Valves (PARTNER 3)3 and Evolut Low Risk4 trials, have further shifted the paradigm by demonstrating noninferiority of TAVR to surgical aortic valve replacement (SAVR) in low-risk surgical patients.
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