Table 1.
Economic evaluations in inoperable patients.
| Author publication year) | Country/perspective/Funding | Model | Agent | Time Horizon | Treatment Incremental costs | Currency | LYG gained | QALY’s gained | Cost-effectiveness (CE) LYG | WTP | Cost-utility (CU) QALY | Other comments |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lorenzoni et al, 2021 [24] | Italy/Italian Health System Perspective/ Industry funded | A Markov model with a 1-month cycle length | SAPIEN 3 vs MM | 15-year horizon. | €11,919 | EUR | Incremental gain: 1.57 LYG TAVI:3.17 LYG MM:1.60 LYG |
Incremental gain: 1.18 QALY TAVI:1.83 QALY MM:0.65 QALY |
€7,577 per LYG | €30,000 | €10,133 per QALY gained | Model was sensitive mortality, re-operation risk for SAVR, risk and costs of hospitalizations for HF and valvuloplasty. |
| Pinar et al, 2021 [21] | Spain/National Health System Perspective/Industry sponsored | Markov model (monthly cycles) with 8 states |
SAPIEN 3 vs MM | 15-year horizon | Incremental costs: €5,434 TAVI: €40, 250 MM:€34, 816 |
EUR | Incremental gain:0.57 LYG TAVI 3.17 LYG MM: 1.60 LYG |
Incremental gain:1.31 QALY TAVI:2.09 QALY MM:0.78 QALY |
€3,454 per LYG | €30,000 | €4,169 per QALY gained | Model was sensitive to the time horizon |
| Inoue et al, 2020 [11] | Japan/ Japanese Public Healthcare Payer Perspective/ Industry Funded | Markov Model | TF TAVI SAPIEN XT vs SoC | Lifetime horizon | TAVI ¥7,654,277 SoC ¥816,682 | JPY | N/R | Incremental gain:1.9758 QALY TAVI: 3. 2607 QALY SoC:1.2849 QALY |
N/R | ¥5,000,000 | ICUR TF-TAVI versus SOC ¥3.5 million perQALY.gained |
Results were sensitive to the utility values of no event survival |
| Kodera et al,2018 [9] | Japan/Japanese Public Healthcare Payer Perspective/ No Funding reported | Markov model with Monte Carlo simulations | TF or TA TAVI vs MM | 10-year horizon | Incremental costs: ¥6,375,062 TF TA TAVI:¥ 8,014,886 MM:¥ 1,639,824 |
JPY | N/R | Incremental gain:1.75 TF TA TAVI: 3.02 QALY MM: 1.27 QALY |
N/R | ¥5,000,000 | ¥3,918,808 per QALY gained | Results were sensitive to the long-term mortality of TAVI and the acquisition cost |
| Brecker et al, 2014 [19] | UK/NHS Perspective/ Industry Funded | Decision-analytic model | TAVI vs MM | 5-year horizon | Incremental costs:£21,038 TAVI: £34,192 MM: £13,154 |
GBP | N/R | Incremental gain:1.51 QALY TAVI:2.29 QALY MM:0.78 QALY |
N/R | £30,000 | £13,943 per QALY gained | Model was sensitive to the HF hospitalisation costs of the MM cohort |
| Hancock et al, 2013 [14] | Canada/ Canadian Public Healthcare system Perspective / Industry Funded | Deterministic decision analytic model | TAVI vs MM | 3-year horizon | Incremental cost: CAD$15,687 TAVI:CAD$58,357 MM CAD$42,670 |
CAD | N/R | Incremental gain: 0.49 QALY TAVI: 1.325 QALY MM: 0.837 QALY |
N/R | CAD$20,000–$100,000 | CAD$32,170 per QALY gained |
Model was sensitive to the time horizon |
| Murphy et al 2013 [16] | UK NHS Perspective / Industry funded | The model employed two parts, a short-term decision tree spanning over the first month and a longer-term Markov model which covered the period from 30 days to death. |
TAVI vs MM | 1 year | Incremental cost:£15,885 TAVI:£28,,061 MM:£12,176 |
GBP | Incremental gain:0.3 LYG TAVI:2.54 LYG MM:2.24 LYG |
Incremental gain:0.44 QALY TAVI:1.63 QALY MM:1.19 QALY |
N/R | £30,000 | £35,956 perQALY gained | The model was sensitive to procedure related events |
| Simons et al 2013 [18] | USA/Societal Perspective / Funded by Public sector | Markov model | TF TAVI vs MM | Lifetime | Incremental cost: $85,600 TAVI: $169,100 MM: $86,300 |
USD | Incremental gain:0.86 LYG TAVI: 2.93 LYG MM:2.08LYG |
Incremental gain: 0.73 QALY TAVI: 1.93 QALY MM:1.19 QALY |
$99,900 per LYG | $100,000 | $116,500 per QALY gained | The results were sensitive to the level of annual healthcare costs unrelated to aortic stenosis |
| Neyt et al 2012 [26] | Belgium/Belgian Health System Perspective /No funding was received | Markov model | TF TAVI SAPIEN vs SoC | Lifetime | Incremental costs: €36,887 TAVI:€40,057 SoC: €3,170 |
EUR | Incremental gain:0.74 LYG | Incremental gain:0.88 QALY | €42,600 per LYG | €44,900 per QALY gained | ||
| Reynolds et al 2012 [23] | USA/US modified societal healthcare system Perspective//Industry funded |
Bootstrap resampling | SAPIEN TAVI vs SoC | Lifetime horizon | Incremental costs: $52,455 TAVI: $106,076 MM: $53,621 | USD | Incremental gain 1.3 LYG TAVI: 2.5 LYG MM: 1.2 LYG |
Incremental gain:1.59 QALY TAVI:2.78 QALY MM:1.2 QALY |
$50,212 per LYG | ≈$70,000 | $61,889 per QALY gained | |
| Watt et al 2012 [15] | UK/ NHS Perspective/ Industry Funded | two interlinked Markov models |
TF TAVI SAPIEN vs MM | 10-year horizon | Incremental costs:£25,200 TAVI: £30,200 MM: £5,000 |
GBP | N/R | Incremental gain:1.56 QALY TAVI;2.36 QALY MM:0.8 QALY |
N/R | £20, 000–£30, 000 | £16,200 per QALY gained | The model was very sensitive to changes to the short-term treatment effect and the cost of the initial operation |
| Doble et al. 2012 [22] | Canada/Third-party Canadian health-care payer /HTA Funded | A combined decision tree and Markov model | TF TAVI SAPIEN vs MM | 20-year horizon | Incremental costs: CAD$31,198 TAVI: CAD $88.891 MM:CAD$57,693 |
CAD | Incremental gain:0.85 LYG | Incremental gain:0.6 QALY | CAD$36,458 per LYG | CAD$50,000 | CAD$51,324 per QALY gained | The model was most sensitive to the procedural costs and 1-year mortality rates for both treatments. The rates of paravalvular leaks and 30-day mortality for the TF-TAVI treatment were also sensitive to change. |
Abbreviations: MM, medical management; SoC, Standard of care; TF, transfemoral; TA, transapical; LYG, life-years gained; QALY, quality -adjusted life years.