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. 2020 Nov 2;20(14):1–148.

Table A24:

Budget Impact Analysis, Full Results, Scenario Analyses

Budget Impact, $ Millionsa
Scenario Analysis Scenario Year 1 Year 2 Year 3 Year 4 Year 5 Total
Reference case Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 32.47 33.76 34.94 36.07 37.23 174.47
Total 32.47 33.76 34.94 36.07 37.23 174.47
New scenario TAVI 20.91 26.17 31.60 37.19 43.00 158.87
SAVR 16.23 13.16 9.81 6.26 2.50 47.96
Total 37.14 39.33 41.42 43.45 45.49 206.83
Budget impact 4.68 5.57 6.48 7.37 8.26 32.36
Scenario 1: increased population with severe aortic valve stenosis Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 35.78 38.97 42.08 45.28 48.56 210.67
Total 35.78 38.97 42.08 45.28 48.56 210.67
New scenario TAVI 23.05 30.23 38.14 46.85 56.38 194.64
SAVR 17.89 15.19 11.81 7.81 3.16 55.86
Total 40.94 45.42 49.95 54.66 59.54 250.50
Budget impact 5.16 6.45 7.87 9.38 10.98 39.83
Scenario 2: expansion of target population, TAVI uptake in patients getting no intervention Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 32.47 33.76 34.94 36.07 37.23 174.47
Total 32.47 33.76 34.94 36.07 37.23 174.47
New scenario TAVI 24.64 29.98 35.49 41.16 47.04 178.30
SAVR 16.23 13.16 9.81 6.26 2.50 47.96
Total 40.87 43.14 45.30 47.41 49.54 226.26
Budget impact 8.40 9.38 10.37 11.34 12.30 51.80
Scenario 3: increased proportion of SAVR patients who are at low surgical risk Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 40.48 42.13 43.56 45.01 46.42 217.59
Total 40.48 42.13 43.56 45.01 46.42 217.59
New scenario TAVI 26.07 32.65 39.40 46.40 53.60 198.13
SAVR 20.24 16.42 12.24 7.80 3.11 59.82
Total 46.31 49.08 51.64 54.21 56.71 257.95
Budget impact 5.83 6.95 8.08 9.20 10.30 40.36
Scenario 4: decreased proportion of SAVR patients who are at low surgical risk Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 24.31 25.28 26.13 27.02 27.86 130.60
Total 24.31 25.28 26.13 27.02 27.86 130.60
New scenario TAVI 15.66 19.59 23.64 27.85 32.18 118.92
SAVR 12.15 9.85 7.34 4.68 1.87 35.90
Total 27.81 29.45 30.98 32.54 34.04 154.82
Budget impact 3.50 4.17 4.85 5.52 6.18 24.22
Scenario 5: increased proportion of SAVR patients eligible for TAVI Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 41.75 43.42 44.90 46.41 47.87 224.35
Total 41.75 43.42 44.90 46.41 47.87 224.35
New scenario TAVI 26.89 33.66 40.62 47.84 55.27 204.29
SAVR 20.87 16.93 12.62 8.05 3.21 61.68
Total 47.77 50.59 53.23 55.89 58.48 265.96
Budget impact 6.02 7.17 8.33 9.48 10.62 41.61
Scenario 6: decreased proportion of SAVR patients eligible for TAVI Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 23.18 24.13 24.94 25.77 26.60 124.61
Total 23.18 24.13 24.94 25.77 26.60 124.61
New scenario TAVI 14.93 18.70 22.56 26.57 30.72 113.48
SAVR 11.59 9.41 7.01 4.47 1.78 34.25
Total 26.52 28.11 29.56 31.04 32.50 147.73
Budget impact 3.34 3.98 4.63 5.27 5.90 23.12
Scenario 7: faster initial uptake Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 32.47 33.76 34.94 36.07 37.23 174.47
Total 32.47 33.76 34.94 36.07 37.23 174.47
New scenario TAVI 31.37 34.20 37.08 40.02 43.07 185.74
SAVR 8.12 6.79 5.33 3.78 2.14 26.16
Total 39.48 40.99 42.42 43.80 45.21 211.90
Budget impact 7.02 7.23 7.48 7.73 7.98 37.43
Scenario 8: gradual uptake Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 32.47 33.76 34.94 36.07 37.23 174.47
Total 32.47 33.76 34.94 36.07 37.23 174.47
New scenario TAVI 8.36 11.74 15.25 18.86 22.61 76.83
SAVR 25.97 24.53 22.85 21.00 19.04 113.39
Total 34.34 36.27 38.09 39.86 41.65 190.22
Budget impact 1.87 2.51 3.16 3.79 4.42 15.75
Scenario 9: cost from probabilistic analyses Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 32.47 33.76 34.94 36.07 37.23 174.47
Total 32.47 33.76 34.94 36.07 37.23 174.47
New scenario TAVI 20.89 26.15 31.59 37.19 43.00 158.82
SAVR 16.23 13.16 9.81 6.26 2.50 47.96
Total 37.13 39.32 41.41 43.44 45.49 206.78
Budget impact 4.66 5.56 6.47 7.37 8.26 32.32
Scenario 10: cost using only BE TAVI Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 32.47 33.76 34.94 36.07 37.23 174.47
Total 32.47 33.76 34.94 36.07 37.23 174.47
New scenario TAVI 20.55 25.69 30.98 36.43 42.07 155.72
SAVR 16.23 13.16 9.81 6.26 2.50 47.96
Total 36.78 38.85 40.80 42.68 44.57 203.68
Budget impact 4.32 5.09 5.86 6.61 7.33 29.21
Scenario 11: cost using only SE TAVI Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 32.47 33.76 34.94 36.07 37.23 174.47
Total 32.47 33.76 34.94 36.07 37.23 174.47
New scenario TAVI 21.27 26.65 32.22 37.96 43.92 162.02
SAVR 16.23 13.16 9.81 6.26 2.50 47.96
Total 37.50 39.81 42.03 44.21 46.42 209.98
Budget impact 5.04 6.05 7.10 8.14 9.18 35.51
Scenario 12: reduced SAVR procedural costs Current scenario TAVI 0.00 0.00 0.00 0.00 0.00 0.00
SAVR 29.69 30.94 32.06 33.15 34.26 160.09
Total 29.69 30.94 32.06 33.15 34.26 160.09
New scenario TAVI 20.91 26.17 31.60 37.19 43.00 158.87
SAVR 14.85 12.07 9.02 5.78 2.35 44.06
Total 35.76 38.24 40.63 42.97 45.34 202.93
Budget impact 6.07 7.30 8.57 9.82 11.09 42.84

Abbreviations: BE, balloon-expandable; SAVR, surgical aortic valve replacement; SE, self-expanding; TAVI, transcatheter aortic valve implantation.

a

Numbers might appear inexact owing to rounding.