TAVI with SAPIEN 3 a cost-effective alternative to SAVR

Transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 valve is a more cost-effective alternative to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic stenosis (sSAS) who are at low risk of surgical mortality, a recent Italy study has found.

Researchers constructed a two-stage utility model to compare healthcare costs and health-related quality of life between the two interventions. In the base case analysis, TAVI with SAPIEN 3 was estimated to have yielded overall benefit by increasing quality-adjusted life years (QALYs), with an incremental improvement of 1.11 per patient, at only a slightly higher cost.

The resulting incremental cost-effectiveness ratio (ICER) was EUR 2,989 (≈USD 3,200) per QALY gained. This was lower than the typical willingness-to-pay (WTP) threshold used in Italy of EUR 30,000 (≈USD 33,100) per QALY gained.

Closer examination of cost breakdown showed that while TAVI demanded higher initial procedural costs than SAVR, savings came from lower costs related to disabling stroke and treated atrial fibrillation.

The main findings were robust to probabilistic sensitivity and scenario analyses. In particular, applying the typical WTP threshold in analysis revealed that TAVI with SAPIEN 3 was cost-effective in 100 percent of simulations. The acceptability curve also showed that TAVI remained cost-effective even when WTP threshold was lowered to EUR 20,000 (≈USD 22,100).

Altering the intervention time horizon did not alter the principal findings; neither did assuming: a more aggressive reintervention rate for TAVI, a higher rate of stroke after TAVI, and no survival benefit.