Table 2.
Economic evaluations in high-risk patients.
| Author publication year) | Country/Perspective /Funding | Study Model | Access | Agents | Time Horizon | Treatment Incremental costs | Currency | LYG gained | QALY’s gained | Cost-effectiveness (CE) LYG | WTP | Cost-utility (CU) QALY | Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lorenzoni et al 2021 [24] | Italy/Italian health system perspective/ Partially funded from industry | Markov Model with 8 different health states | NR | TAVI SAPIEN 3 vs SAVR | 15-year time horizon | Incremental costs: €3,831 TAVI: €37,189 SAVR: €33,358 |
EUR | Incremental gain: 0.41 LYG TAVI: 4.49 LYG SAVR: 4.08 LYG |
Incremental gain:0.34 QALY TAVI:2.83 QALY S AVR:2.49 |
€9,474 per LYG | €30,000 | €11,209 per QALY gained | Model was sensitive to mortality, to major incidence of stroke and repeated hospitalizations for AS. |
| Inoue et al, 2020 [11] | Japan/Japanese Public healthcare Payer perspective/ Industry Funded | Decision tree model for the first two years and a Markov model | TA/TF | TAVI SAPIEN XT vs SAVR | Lifetime | Incremental costs:¥1,556,750 TAVI:¥ 7, 725,818 SAVR: ¥6,169, 068 |
JPY | N/R | Incremental gain: 1.19 QALY TAVI: 5.558 QALY SAVR: 4.3946 QALY |
N/R | ¥ 5,000,000 . | ¥1,337,525 per QALY gained | Model was sensitive to mortality of SAVR patients after 24 months |
| Tarride et al 2019 [44] | Canada/ Canadian third-party payer perspective/Industry Funded | Markov Model with 9 exclusive states | NR | TAVI SAPIEN 3 vs SAVR | 15-year time horizon | Incremental costs: CAD$7,362 TAVI:CAD$84,348 SAVR: CAD$76,986 |
CAD | N/R | Incremental gain:0.42 QALY TAVI: 3.57 QALY SAVR: 3.15QALY |
N/R | CAD$50.000 | CAD$ 17,237 per QALY gained | Model was sensitive to the time horizon |
| Doble et al, 2012 [22] | Canada/ Third-party Canadian health-care payer/Funded | A combined decision tree and Markov model | TAVI (transfemoral or transapical) vs SAVR | TAVI SAPIEN vs SAVR | 20 years | Incremental Costs:CAD$11,153 TAVI: CAD $85,755 SAVR:CAD $74,602 |
CAD | Incremental gain: 0.012 LYG |
Incremental gain: 0.102 QALY | ICER CAD$870,143 per LYG | CAD$50,000 | SAVR dominated TAVI | |
| Povero et al, 2018 [35] | Australia/ Third-party payer perspective/ Industry Funded | Patient-level discrete event simulation (DES) structure, wit a cohort Markov model |
NR | TAVI vs Sutureless bioprosthesis Perceval ® | Lifetime | Incremental costs:–$10,016 | AUD | Incremental gain:-1.25 LYG TAVI: 4.26 LYG SU AVR: 5.51 LYG |
Incremental gain:-1.14QALY TAVI: 3.44 QALY SU AVR: 4.58 QALY | TAVI WAS DOMINATED | AUD $50,000 | TAVI WAS DOMINATED | Model was sensitive to PVL, time horizon and efficacy discount rate. |
| Povero et al, 2018 [35] | France/ Third-party payer perspective/ Industry Funded | Patient-level discrete event simulation (DES) structure, wit a cohort Markov model |
NR | TAVI vs Sutureless bioprosthesis Perceval® | Lifetime | Incremental costs:–€3,504 | EUR | Incremental gain: −1.25 TAVI: 4.26 SU AVR: 5.51 |
Incremental gain:-1.14QALY TAVI: 3.44 QALY SU AVR: 4.58 QALY | TAVI WAS DOMINATED | €30,000 | TAVI WAS DOMINATED | Model was sensitive to PVL, time horizon and efficacy discount rate. |
| Povero et al, 2018 [35] | Germany / Third-party payer perspective/Industry Funded | Patient-level discrete event simulation (DES) structure, wit a cohort Markov model |
TAVI vs Sutureless bioprosthesis Perceval® | Lifertime | Incremental Costs:–€6,772 | EUR | Incremental gain: −1.25 TAVI: 4.26 SU AVR: 5.51 |
Incremental gain:-1.14QALY TAVI: 3.44 QALY SU AVR: 4.58 QALY | TAVI WAS DOMINATED | €45,000 | TAVI WAS DOMINATED | Model was sensitive to PVL, time horizon and efficacy discount rate. | |
| Povero et al, 2018 [35] | Italy/ Third-party payer perspective /Industry Funded | Patient-level discrete event simulation (DES) structure, wit a cohort Markov model |
NR |
TAVI vs Sutureless bioprosthesis Perceval® | Lifetime | Incremental Costs:–€6,570 | EUR | Incremental gain: −1.25 TAVI: 4.26 SU AVR: 5.51 |
Incremental gain:-1.14QALY TAVI: 3.44 QALY SU AVR: 4.58 QALY | TAVI WAS DOMINATED | €30,000 | TAVI WAS DOMINATED | Model was sensitive to PVL, time horizon and efficacy discount rate. |
| Povero et al, 2018 [35] | UK/ Third-party payer perspective/ Industry Funded | Patient-level discrete event simulation (DES) structure, wit a cohort Markov model |
NR |
TAVI vs Sutureless bioprosthesis Perceval® | Lifetime | Incremental costs:–£7,991 | GBP | Incremental gain: −1.25 LYG TAVI: 4.26 LYG SU AVR: 5.51 LYG |
Incremental gain:-1.14QALY TAVI: 3.44 QALY SU AVR: 4.58 QALY | TAVI WAS DOMINATED | £30,000 | TAVI WAS DOMINATED | Model was sensitive to PVL, time horizon and efficacy discount rate. |
| Povero et al, 2018 [35] | USA/ Third-party payer perspective/ Industry Funded | patient-level discrete event simulation (DES) structure, wit a cohort Markov model |
NR |
TAVI vs Sutureless bioprosthesis Perceval® | Lifetime | Incremental costs:–$20,930 | USD | Incremental gain: −1.25 LYG TAVI: 4.26 LYG SU AVR: 5.51LYG |
Incremental gain:-1.14 QALY TAVI: 3.44 QALY SU AVR: 4.58 QALY |
TAVI WAS DOMINATED | US$100,000 | TAVI WAS DOMINATED | Model was sensitive to PVL, time horizon and efficacy discount rate. |
| Geisler et al 2017 [42] | The Netherlands / Health care perspective / Industry Funded | Markov Model | NR | TAVI EVOLUT vs SAVR | Lifetime | Incremental costs:€9,048 TAVI €51,068 SAVR €42,020 |
EUR | N/R | Incremetnal gain: 0.42 QALY TAVI: 3.69 QALY SAVR :3.27 QALY | N/R | AS has a disease burden 0.43. For a disease burden between 0.41 and 0.70 the appropriate cost-effectiveness threshold is €50,000/QALY in the Netherlands | €21,946 per QALY gained | Model was sensitive to procedure time and hospital stay |
| Reynolds et al.2016[41] | USA/Societal perspective/ Industry Funded | Trial-based | TF/TA | TAVI vs SAVR | Lifetime | Incremental costs:$17,849 TAVI: US$207,478 SAVR: US$189, 629 |
USD | Incremental gain:0.41 LYG TAVI:5.469 LYG SAVR:5.055 LYG | Incremental gain:0.324 QALY TAVI:4.149 QALY SAVR:3.825 QALY | US$43,114/LYG | $50, 000 | US$55090 per QALY gained |
Model was sensitive to the cost of TAVI |
| Freeman et al 2016[30] | UK/UK NHS/ Funding not reported | Decision analytic model | N/R | TAVI vs MM | 5-year time horizon | Incremental costs:£13,655TAVI: £44,751 MM: £31,096 |
GBP | Incremental gain:1.73 LYG | Incremental gain: 1.29 QALY | £20, 000–£30,000 | £10,533 per QALY gained | ||
| Fairbairn et al. 2013[29] | UK/ UK NHS perspective/ Funded by the British Heart Foundation | Decision tree and Markov model | TF/TA | TF/TA TAVI vs SAVR | 10-year time horizon | Incremental costs--£1,350.38 TAVI: £52,593.02 SAVR: £53,943.40 |
GBP, | N/R | Incremental gain:0.06 QALY TAVI:2.81 QALY SAVR:2.75 QALY | N/R | £20,000–£30, 000 | TAVI dominated SAVR | Model was sensitive to the cost of the tavi and the length of stay following the TAVI procedure. |
| Orlando et al 2013 [4 5] | UK/NHS perspective/ Funded by HTA programme | Decision tree | TF/TA | TAVI vs SAVR | 25-year time horizon | Incremental Costs: £7,962 TAVI: £2,833 SAVR: £19,871 |
GBP, | N/R | Incremental gain:- 0.51 QALY TAVI: 2.85 QALY SAVR: 3.46 QALY | N/R | £20, 000–£30, 000 | TAVI is dominated | |
| Gada et al. 2012[31] | USA/ Thid party payer perspective/ Funding not reported | Single Markov model | TA | TAVI SAPIEN vs MM and SAVR ( | Incremental costs:$100 TAVI: US$56, 730 AVR: US$56, 630 |
USD | N/R | Incemental gain: −0.03 QALY TAVI:1.66 QALY SAVR:1.7 QALY |
N/R | US$100,000 | SAVR dominated TAVI SAVR vs MM $42,637 per QALY gained TAVI vs MM US$44,384 per QALY gained |
Their model was sensitive to variations in the probabilities of peri-operative, annual mortality after each intervention, and the probability of annual stroke following AVR. | |
| Gada et al 2012[34] | USA/Perspective of health care funding body / Funding not reported | Single Markov model | TF | TAVI SAPIEN vs MM and SAVR | Lifetime | Base case TAVI: US$59, 503 SAVR: US$56, 339 PARTNER A scenario TAVI: US$85, 513 SAVR: US$82, 989 PARTNER COSTS TAVI: US$81, 446 SAVR: US$79, 526 |
USD | TAVI:1.78 PARTNER A:1.78 PARTNER:2.14 AVR 1.72 PARTNER A:1.72 PARTNER B 2.15 |
US$100,000 | TAVI vs MM $39,964 per QALY gained SAVR vs MM $39,280 per QALY gained Base case TAVI vs SAVR US$52, 773 per QALY gained PARTNER scenario US$252,400 per QALY gained PARTNER COST US$32, 000 per QALY gained |
Model was sensitive t0 perioperative and annual mortality after AVR and after TAVI, and the probability of annual stroke after TAVI, are important determinants of the favored strategy | ||
| Neyt et al.23 2012[26] | Belgium/ Belgian Health Care Payer/ No funding was received | Single Markov model | TF/TA | TAVI SAPIEN vs SAVR SAPIEN | One year time horizon | Incremental costs:€20,397 | EUR | Incremetnak gain: 0.03 | €35, 000 | Exceeding 750,000 per QALY gained | |||
| Reynolds et al.2012[40] | USA/U.S. modified societal health care system perspective/ No funding reported | Trial-based | TF/TA | TAVI SAPIEN vs SAVR | One year time horizon | Incremental costs:$2,070 TAVI:$100,504 SAVR:$98,434 Transapical Incremental costs $11,896 TAVI $90,919 SAVR $79,024 TRANSFEMORAL Incremental costs:-$1250 Transfemoral TAVI $96,743 SAVR $97,992 |
USD | TAVI (TF-TA): 0.858 SAVR: 0.817 TAVI (TF): 0.878 SAVR: 0.813 TAVI (TA): 0.811 SAVR: 0.826 |
TAVI (TF-TA): 0.633 SAVR: 0.606 TAVI (TF): 0.659 SAVR: 0.591 TAVI (TA): 0.570 SAVR: 0.641 |
US$50000 | TAVI (TF- TA) vs SAVR US$76,877 per QALY gained SAVR dominated Transapical TAVI Transfemoral TAVI dominated SAVR |
Abbreviations: TF, transfemoral; TA, transapical;SAVR, Surgical aortic valve replacement; MM, Medical Management