Naidoo T, Pietzsch JB, Oyuyi A, Visser E, Ceronio B, Badarneh A, Koen W. Cost effectiveness analysis of new and prior generation transcatheter aortic valve replacement compared to surgical valve replacement in a South African context. Presentation at the Pan-African Society of Cardiology, South Africa Heart Association, and Africa PCR Congress, Johannesburg, South Africa, October 31–November 3, 2019. Cardiovasc J S Afr. 2019;30(5, suppl):S31. Available online.

Objectives. For private medical insurance carriers in South Africa, the cost of transcatheter aortic valve implantation (TAVI) has been assumed to be higher than surgical aortic valve replacement (SAVR). However, health economic work conducted in 2014 showed TAVI to be cost-effective compared with SAVR. Our objective was to estimate the cost-effectiveness of a contemporary self-expanding TAVI device among patients at high surgical risk in the South African healthcare system.

Methods. We used a previously developed decision-analytic (Markov) model based on the CoreValve High Risk study to estimate lifetime gains in quality-adjusted life years (QALYs) and lifetime incremental cost-effectiveness. Costs and resource utilization for South Africa were derived from the South African SHARE-TAVI registry, hospital billing data, fee schedules, and published literature. We then conducted a scenario analysis based on the application of second-generation self-expanding TAVI devices.

Results. Over patients’ lifetimes, TAVI was projected to add 0.32 QALYs. Hospital length of stay was found to be markedly lower for TAVI compared to SAVR (respectively, 2.6 vs. 6.2 ICU days; and 5.7 vs. 12.1 total days), thereby offsetting higher TAVI procedure costs. Total estimated costs were R51,434 higher for the TAVI strategy, leading to an approximated incremental cost-effectiveness ratio (ICER) of R161,236 per QALY. Using second-generation devices reduced the cost difference to R41,954 per QALY. Such ICER estimates suggest that TAVI is cost-effective relative to a South African willingness-to-pay threshold of approximately R300,000 per QALY.

Conclusions. Our analysis suggests that among patients at high surgical risk, TAVI using self-expanding devices is a cost-effective intervention in the South African healthcare system. The use of second-generation devices may further improve this favorable value proposition.