Table 10:

Results of Economic Literature Review—Summary

Name, Year, Location	Analytic Technique, Study Design, Time Horizon, Perspective	Population	Intervention/Comparator	Resultsa
				Health Outcomes	Costs	Cost-effectiveness	Uncertainty
Kodera et al, 2018,41 Japan	Cost-utility analysis Markov model (monthly cycle) 10-year time horizon Japanese public health care payer perspective	Adults with severe AVS at intermediate surgical riskb Male: TAVI 55%; SAVR 55% Average age: TAVI 82 y; SAVR 82 y	Intervention: TF TAVI (clinical inputs taken from PARTNER 2 trial and OCEAN TAVI registry) Comparator: SAVR	Reference case Discounted 2% TF TAVI: 4.81 QALYs SAVR: 4.59 QALYs Incremental: 0.22 QALYs	Reference case Japanese yenc Discounted 2% TF TAVI: ¥8,039,694 (¥95,000 CAD) SAVR: ¥6,316,178 (∼$75,000 CAD) Incremental: ¥1,723,516 (∼$20,000 CAD)	Reference case Discounted 2% ICER (TF TAVI vs. SAVR): ¥7,523,821/ QALY (∼$89,000 CAD)	Probabilistic sensitivity analysis TF TAVI probability of cost-effectiveness: 46% at WTP of ¥5,000,000/ QALY (∼$60,000 CAD) TF and TT scenario ICER (TAVI vs. SAVR): ¥56,528,188/QALY (∼$668,000 CAD)
Tam et al, 2018,16 Canada	Cost-utility analysis Markov model (30-day cycles) Lifetime horizon Ontario Ministry of Health perspective	Adults with severe AVS at intermediate surgical riskb Male: TAVI 54.2%; SAVR 54.8% Average age: TAVI 81.5 y; SAVR 81.7 y	Intervention: TAVI (clinical inputs taken from PARTNER 2 trial) Comparator: SAVR	Reference case (± SD) Discounted 1.5% TAVI: 5.63 QALYs (± 1.47) SAVR: 5.40 QALYs (± 1.47) Incremental: 0.23 QALYs Undiscounted TAVI: 6.18 QALYs (± 1.60) SAVR: 5.92 QALYs (± 1.63) Incremental: 0.26 QALYs	Reference case (± SD) 2016 Canadian dollars Discounted 1.5% TAVI: $46,904 (± 4,038) SAVR: $36,356 (± 7,309) Incremental: $10,548 Undiscounted TAVI: $47,054 (± 4,113) SAVR: $36,478 (± 7,261) Incremental: $10,576	Reference case Discounted 1.5% ICER (TAVI vs. SAVR): $46,083/QALY Undiscounted ICER (TAVI vs. SAVR): $39,661/QALY	Probabilistic sensitivity analysis TAVI probability of cost-effectiveness: 52.7% at WTP of $50,000/QALY 55.4% at WTP of $100,000/QALY TF scenario ICER (TAVI vs. SAVR): $24,790/QALYd
Tam et al, 2018,17 Canada	Cost-utility analysis Markov model (30-day cycles) Lifetime horizon Ontario Ministry of Health Perspective	Adults with severe AVS at intermediate surgical riskb Male: TAVI 54.2%; SAVR 54.8% Average age: TAVI 79.9 y; SAVR 79.8 y	Intervention: TAVI (clinical inputs taken from SURTAVI trial) Comparator: SAVR	Reference case (± SD) Discounted 1.5% TAVI: 6.42 QALYs (± 1.33) SAVR: 6.28 QALYs (± 1.32) Incremental: 0.15 QALYs Undiscounted TAVI: 7.03 QALYs (± 1.47) SAVR: 6.87 QALYs (± 1.46) Incremental: 0.16 QALYs	Reference case (± SD) 2016 Canadian dollars Discounted 1.5% TAVI: $44,299 (± 7,260) SAVR: $32,994 (± 13,434) Incremental: $11,305 Undiscounted TAVI: $44,377 (± 7,263) SAVR: $33,085 (± 13,436) Incremental: $11,292	Reference case Discounted 1.5% ICER (TAVI vs. SAVR): $76,736/QALY Undiscounted ICER (TAVI vs. SAVR): $71,043/QALY	Probabilistic sensitivity analysis TAVI probability of cost-effectiveness: 52.9% at WTP of $50,000/QALY 57.2% at WTP of $100,000/QALY

Abbreviations: AVS, aortic valve stenosis; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; SAVR, surgical aortic valve replacement; SD, standard deviation; TAVI, transcatheter aortic valve implantation; TF, transfemoral; TT, transthoracic; WTP, willingness-to-pay.

^aNumbers may appear inexact due to rounding.

^bBased on criteria from the randomized controlled trials, which were based on clinical assessment by a multidisciplinary heart team, informed by the Society of Thoracic Surgery Predicted Risk of Mortality (STS-PROM) score, coexisting conditions, frailty, and disability.

^cUnclear what year costs were calculated in.

^dTransfemoral scenario: TAVI vs. SAVR, incremental QALYs 0.40 and incremental costs $9,815.