Busca R, Geisler BP, Pietzsch JB. Cost-effectiveness of transcatheter aortic valve replacement: current decision-analytic models and future opportunities [Presentation to the 2015 annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research, abstract PMD84]. Value Health. 2015;18(7):A359; doi: 10.1016/j.jval.2015.09.686.

Objectives. Transcatheter aortic valve replacement (TAVR) is an important new therapy approach for the treatment of severe aortic stenosis. Our objective was to identify and review the growing body of published cost-effectiveness analyses of TAVR, and to identify opportunities for future modeling and analyses in light of new clinical evidence.

Methods. A systematic search in PubMed, Embase, and health technology assessment (HTA) agency databases and a grey search were conducted for the period from 2005 through 2014 to identify studies examining the cost-effectiveness of aortic valve replacement using a transcatheter-based intervention. Searches, study selection, and data extraction were performed according to a predefined protocol. We only included studies on cost-effectiveness of TAVR compared with either medical management or surgery (SAVR). Appraised studies were analyzed using the consolidated health economic evaluation reporting standards (CHEERS) checklist.

Results. Our search yielded 15 studies, comprising 13 distinct decision-analytic models set in six countries: Belgium, Brazil, Canada, Spain, the United Kingdom, and the United States. Four of the models were developed by national HTA agencies or academic groups. In some cases, HTA reports differed from the published results. Study quality per CHEERs criteria was poor to excellent.

Among the 15 studies, seven employed models that compared TAVR to medical management; two to surgery; and five evaluated the cost-effectiveness of TAVR in comparison to both. Efficacy data from Partner A and B were used by 13 of the studies. Only one study used patient-level data in an “along-the-trial” design. In studies comparing TAVR to medical management, incremental cost-effectiveness ratios (ICERs) ranged from £12,600 to $115,600 per quality-adjusted life year. Compared with SAVR, ICER estimates ranged from TAVR dominating to being dominated.

Conclusions. Economic evaluations are lagging behind published clinical evidence. Future opportunities include economic evaluation of newer clinical trial data, long-term follow-up data from earlier studies, and more explicit evaluation of subsets of patient cohorts. Overall model quality and reporting of methods, including data sources, could be improved further.