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Early cost-utility analysis of tissue-engineered heart valves compared to bioprostheses in the aortic position in elderly patients

Author

Listed:
  • Simone A. Huygens

    (University Medical Center
    Erasmus University
    Erasmus University)

  • Isaac Corro Ramos

    (Erasmus University)

  • Carlijn V. C. Bouten

    (Eindhoven University of Technology)

  • Jolanda Kluin

    (Academic Medical Centre)

  • Shih Ting Chiu

    (Providence Health and Service)

  • Gary L. Grunkemeier

    (Providence Health and Service)

  • Johanna J. M. Takkenberg

    (University Medical Center)

  • Maureen P. M. H. Rutten-van Mölken

    (Erasmus University
    Erasmus University)

Abstract

Objectives Aortic valve disease is the most frequent indication for heart valve replacement with the highest prevalence in elderly. Tissue-engineered heart valves (TEHV) are foreseen to have important advantages over currently used bioprosthetic heart valve substitutes, most importantly reducing valve degeneration with subsequent reduction of re-intervention. We performed early Health Technology Assessment of hypothetical TEHV in elderly patients (≥ 70 years) requiring surgical (SAVR) or transcatheter aortic valve implantation (TAVI) to assess the potential of TEHV and to inform future development decisions. Methods Using a patient-level simulation model, the potential cost-effectiveness of TEHV compared with bioprostheses was predicted from a societal perspective. Anticipated, but currently hypothetical improvements in performance of TEHV, divided in durability, thrombogenicity, and infection resistance, were explored in scenario analyses to estimate quality-adjusted life-year (QALY) gain, cost reduction, headroom, and budget impact. Results Durability of TEHV had the highest impact on QALY gain and costs, followed by infection resistance. Improved TEHV performance (− 50% prosthetic valve-related events) resulted in lifetime QALY gains of 0.131 and 0.043, lifetime cost reductions of €639 and €368, translating to headrooms of €3255 and €2498 per hypothetical TEHV compared to SAVR and TAVI, respectively. National savings in the first decade after implementation varied between €2.8 and €11.2 million (SAVR) and €3.2–€12.8 million (TAVI) for TEHV substitution rates of 25–100%. Conclusions Despite the relatively short life expectancy of elderly patients undergoing SAVR/TAVI, hypothetical TEHV are predicted to be cost-effective compared to bioprostheses, commercially viable and result in national cost savings when biomedical engineers succeed in realising improved durability and/or infection resistance of TEHV.

Suggested Citation

  • Simone A. Huygens & Isaac Corro Ramos & Carlijn V. C. Bouten & Jolanda Kluin & Shih Ting Chiu & Gary L. Grunkemeier & Johanna J. M. Takkenberg & Maureen P. M. H. Rutten-van Mölken, 2020. "Early cost-utility analysis of tissue-engineered heart valves compared to bioprostheses in the aortic position in elderly patients," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(4), pages 557-572, June.
    • Handle: RePEc:spr:eujhec:v:21:y:2020:i:4:d:10.1007_s10198-020-01159-y
    DOI: 10.1007/s10198-020-01159-y
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    Cited by:

    1. Jesús Isaac Vázquez-Serrano & Rodrigo E. Peimbert-García & Leopoldo Eduardo Cárdenas-Barrón, 2021. "Discrete-Event Simulation Modeling in Healthcare: A Comprehensive Review," IJERPH, MDPI, vol. 18(22), pages 1-20, November.

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    More about this item

    Keywords

    Early health technology assessment; Patient-level simulation model; Heart valve implantation; Tissue-engineered heart valves;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I19 - Health, Education, and Welfare - - Health - - - Other

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