Sondergaard L, Geisler B, Jorgensen T, Thyregod HG, Pietzsch J. Cost-effectiveness of transcatheter versus surgical aortic valve replacement in patients at lower surgical risk [abstract POS258]. Presentation at EuroPCR 2018, Paris, 22–25 May 2018. Available at: https://abstractbook.pcronline.com/index/slide/abstract/100432/search/sondergaard. Accessed November 4, 2018.

Objectives. Clinical non-inferiority between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) has previously been demonstrated in a patient cohort with severe aortic stenosis at lower surgical risk. However, the cost-effectiveness of TAVI is uncertain in this patient population.

Methods and Results. Mortality, event rates, and resource utilization were derived from the primary dataset of the low surgical risk NOTION trial. Patient’s mean age was 79.1 ±4.8 years at baseline and their Society of Thoracic Surgeons predicted risk of mortality score was 3.0±1.6. Costs and effectiveness as quality-adjusted life years (QALYs) were projected to lifetime via a decision-analytic model calibrated to 48-month incidences of all-cause mortality, stroke, and myocardial infarction from the NOTION trial. The base case assumed a scenario in which any mortality benefit would gradually fade out over time, with other scenarios explored in sensitivity analyses. The discounted incremental cost-effectiveness ratio (ICER) was compared to the country-specific willingness-to-pay (WTP) threshold of 1.13 million Danish kroner (DKK). The base case life expectancy were 7.59 and 7.35 for TAVI and SAVR, respectively. The base case ICER was DKK425,890 per QALY. Variation in long-term mortality beyond 4 years led to limited variation of incremental costs (DKK73,600 to 75,100), but a more pronounced variation in incremental QALYs (0.14 to 0.28 QALYs for most conservative and optimistic assumptions, compared to base case of 0.16 QALYs). All resulting ICERs (range DKK271,300 to DKK531,000 per QALY gained) were below the WTP threshold.

Conclusions. TAVI in a low-surgical risk cohort was found to be a cost-effective treatment strategy in the Danish setting. Cost-effectiveness analyses in other settings, and with contemporary next-generation devices are warranted as is long-term follow-up of trials and registries given the sensitivity of the model to long-term mortality.