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Cost-effectiveness of transcatheter aortic valve implantation in patients at low surgical risk in France: a model-based analysis of the Evolut LR trial

Author

Listed:
  • Didier Tchétché

    (Clinique Pasteur)

  • Coline Dubois Gennes

    (Amaris)

  • Quentin Cormerais

    (Medtronic, Plc)

  • Benjamin P. Geisler

    (Massachusetts General Hospital, Harvard Medical School
    Wing Tech Inc.)

  • Camille Dutot

    (Medtronic, Plc)

  • Fanny Wilquin-Bequet

    (Medtronic, Plc)

  • Manon Breau-Brunel

    (Amaris)

  • Béranger Lueza

    (Amaris)

  • Jan B. Pietzsch

    (Wing Tech Inc.)

Abstract

Background In the recent Evolut Low Risk randomized trial, transcatheter aortic valve implantation (TAVI) was shown to be non-inferior to surgery (SAVR) regarding the composite end point of all-cause mortality or disabling stroke at 24 months. Aims To evaluate the cost-effectiveness of self-expandable TAVI in low-risk patients, using the French healthcare system as the basis for analysis. Methods Mortality, health-related quality of life, and clinical event rates through two-year follow-up were derived from trial data (N = 725 TAVI and N = 678 SAVR; mean age: 73.9 years; mean STS-PROM: 1.9%). Cost inputs were based on real-world data for TAVI and SAVR procedures in the French healthcare system. Costs and effectiveness as quality-adjusted life years (QALYs) were projected to lifetime via a decision-analytic model under assumption of no mortality difference beyond two years. The discounted incremental cost-effectiveness ratio (ICER) was evaluated against a willingness-to-pay threshold of €50,000 per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted, including assumptions about differential long-term survival. Results For the base case, mean survival was 13.69 vs 13.56 (+ 0.13) years for TAVI and SAVR, respectively. Discounted QALYs were 9.34 vs. 9.21 (+ 0.13) and discounted lifetime costs €52,267 vs. €51,433 (+ €833), resulting in a lifetime ICER of €6368 per QALY gained. In probabilistic sensitivity analysis, TAVI was found dominant or cost-effective in 74.4% of samples. Conclusion TAVI in patients at low surgical risk is a cost-effective alternative to SAVR in the French healthcare system. Longer follow-up data will help increase the accuracy of lifetime survival projections. Graphical Abstract

Suggested Citation

  • Didier Tchétché & Coline Dubois Gennes & Quentin Cormerais & Benjamin P. Geisler & Camille Dutot & Fanny Wilquin-Bequet & Manon Breau-Brunel & Béranger Lueza & Jan B. Pietzsch, 2024. "Cost-effectiveness of transcatheter aortic valve implantation in patients at low surgical risk in France: a model-based analysis of the Evolut LR trial," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(3), pages 447-457, April.
    • Handle: RePEc:spr:eujhec:v:25:y:2024:i:3:d:10.1007_s10198-023-01590-x
    DOI: 10.1007/s10198-023-01590-x
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    Keywords

    Aortic valve stenosis; Transcatheter aortic valve implantation; Surgical aortic valve replacement; Cost–benefit analysis; Health-related quality of life; France;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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