Iannaccone, A and Marwick, TH, Cost Effectiveness of Transcatheter Aortic Valve Replacement Compared with Medical Management or Surgery for Patients with Aortic Stenosis, Applied Health Economics and Health Policy, 13, (1) pp. 29-45. ISSN 1175-5652 (2015) [Refereed Article]
Copyright Springer International Publishing Switzerland 2014
Aim: The aim of this review was to assess the results and quality of the economic evaluations in the current literature and to identify the drivers of cost effectiveness.
Methods: We performed an electronic data search using four different electronic databases, selecting all studies that included cost-effectiveness data for TAVR compared with either medical management or surgery. Sixteen studies were evaluated for a qualitative and quantitative assessment.
Results: The quality of the cost-effectiveness analyses (CEAs) were generally sufficient. In contrast, we found an extreme heterogeneity of input assumptions with consequent difficulties to generalize the conclusions. However, in the population of patients with severe symptomatic AS and a prohibitive surgical risk, TAVR generally represents a good choice, with incremental costs that are well balanced by the great benefit in terms of quality of life and survival. Nevertheless, the cost effectiveness of this procedure in the real world, particularly in patients with high healthcare costs from other comorbid conditions, may be less favorable. In AS patients with high (but not prohibitive) surgical risk, the choice between TAVR and SAVR is still debatable. Both procedures are comparable in terms of efficacy and safety but the evidence is inconclusive from an economic point of view.
Conclusions: On the basis of this review, it was ascertained that the details of risk evaluation and patient selection will be critical in understanding how improvements in survival can be used to target the use of TAVR to ensure the cost-effective and sustainable use of resources.
|Item Type:||Refereed Article|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Cardiovascular medicine and haematology|
|Research Field:||Cardiology (incl. cardiovascular diseases)|
|Objective Group:||Clinical health|
|Objective Field:||Clinical health not elsewhere classified|
|UTAS Author:||Iannaccone, A (Dr Andrea Iannaccone)|
|UTAS Author:||Marwick, TH (Professor Tom Marwick)|
|Year Published:||2015 (online first 2014)|
|Web of Science® Times Cited:||10|
|Deposited By:||Menzies Institute for Medical Research|
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