Transcatheter aortic valve implantation versus surgical aortic valve replacement in severe aortic stenosis patients at low surgical mortality risk: a cost-effectiveness analysis in Belgium.

Dubois, Christophe;Adriaenssens, Tom;Annemans, Lieven;Bosmans, Johan;Wyffels, Eric;et.al.
(2024) Acta Cardiologica : an international journal of cardiology — Vol. 79, n° 1, p. 46-57 (2024)

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Authors
  • Dubois, Christopheorcid-logo
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  • Adriaenssens, Tom
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  • Annemans, Lieven
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  • Bosmans, Johan
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  • Kefer, JoëlleUCLouvain
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  • Wyffels, Eric
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Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 device has recently shown significant clinical benefits, compared to surgical aortic valve replacement (SAVR), in patients at low risk for surgical mortality (PARTNER 3 trial, NCT02675114). Currently in Belgium, TAVI use is restricted to high-risk or inoperable patients with severe symptomatic aortic stenosis (sSAS). This cost-utility analysis aimed to assess whether TAVI with SAPIEN 3 could lead to potential cost-savings compared with SAVR, in the low-risk sSAS population in Belgium. METHODS: A previously published, two-stage, Markov-based cost-utility model was used. Clinical outcomes were captured using data from PARTNER 3 and the model was adapted for the Belgian context using cost data from the perspective of the Belgian National Healthcare System, indexed to 2022. A lifetime horizon was chosen. The model outputs included changes in direct healthcare costs, survival and health-related quality of life using TAVI versus SAVR. RESULTS: TAVI with SAPIEN 3 provides meaningful clinical and cost benefits over SAVR, in terms of an increase in quality-adjusted life years (QALYs) of 0.94 and cost-saving of €3 013 per patient. While initial procedure costs were higher for TAVI compared with SAVR, costs related to rehabilitation, disabling stroke, treated atrial fibrillation, and rehospitalization were lower. The cost-effectiveness of TAVI over SAVR remained robust in sensitivity analyses. CONCLUSION: TAVI with SAPIEN 3 may offer a meaningful alternative intervention to SAVR in Belgian low-risk patients with sSAS, showing both clinical benefits and cost savings associated with post-procedure patient management.
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Dubois, C., Adriaenssens, T., Annemans, L., Bosmans, J., Callebaut, B., Candolfi, P., Cornelis, K., Delbaere, A., Green, M., Kefer, J., Lancellotti, P., Rosseel, M., Shore, J., Van Der Heyden, J., Vermeersch, S., & Wyffels, E. (2024). Transcatheter aortic valve implantation versus surgical aortic valve replacement in severe aortic stenosis patients at low surgical mortality risk: a cost-effectiveness analysis in Belgium. Acta Cardiologica : an international journal of cardiology, 79(1), 46-57. https://doi.org/10.1080/00015385.2023.2282283 (Original work published 2024)