Reardon MR, Bosmans JM, Geisler BP, Pietzsch JB. Cost-effectiveness of transcatheter aortic valve implantation in patients at high surgical risk in the Belgian healthcare system: an exploratory analysis using contemporary data [abstract Lond19A-POS074, online]. Poster presentation at PCR London Valves, London, November 17–19, 2019. Available at: https://abstractbook.pcronline.com/export/pdf/id/150083.

Objectives. In Belgium, the use of transcatheter aortic valve implantation (TAVI) to treat severe aortic stenosis is currently limited to patients for whom surgical implantation represents an extreme or high risk. It is also subject to a volume cap. No cost-effectiveness analyses have been published in this setting for close to a decade, with previous analyses relying on early evidence from the study of balloon-expanding TAVI devices. Our objective was to generate an estimate of the potential cost-effectiveness of TAVI compared to surgical aortic valve replacement (SAVR) in high-risk patients, using contemporary data from studies of self-expanding TAVI devices.

Methods. We obtained detailed procedure costs using 2018 device reimbursement, physician fees, and a lump sum amount for materials. Hospitalization costs were derived from a health technology assessment and adjusted to 2018 costs. In addition, an alternative calculation of index treatment costs was derived from a random sample of 2018 hospital bills collected from Antwerp University Hospital (11 TAVI, 9 SAVR). Relevant adverse event costs through 2 years after index procedure were considered based on incidents observed in the CoreValve HR trial and costs derived from the Belgian APR-DRG system. Lifetime health outcomes for the high-risk population were computed using a previously published decision-analytic model projecting unadjusted and quality-adjusted life year (LY, QALY) gains based on Belgian lifetable data. A discount rate of 3.0% and 1.5% was applied to costs and QALYs, respectively.

Results. Over the simulated patient’s lifetime, TAVI was projected to add 0.64 LYs (5.45 vs. 4.81) and 0.41 QALYs. TAVI lifetime costs were €8,518 (€37,669 vs. €29,151) and €9,093 (€33,851 vs. €24,758) higher than SAVR costs, using the first and second approaches to index cost calculation, respectively. The actual hospital bill-based approach yielded length of stay estimates of 11.8 vs. 10.9 days for TAVI and SAVR, respectively. The resulting estimated cost-effectiveness was €20,877/QALY and €22,286/QALY for the two approaches, respectively.

Conclusions. The results of this exploratory analysis suggest that TAVI is a cost-effective intervention for high-risk patients in the Belgian healthcare system. Our findings underscore the need to consider contemporary data to inform decisionmaking about expanded therapy adoption.