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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Cost-effective analysis of transcatheter aortic valve replacement in patients with severe symptomatic aortic

Makoto Amaki1, Kensuke Moriwaki2, Michikazu Nakai3

  • 1Department of Heart Failure and Transplant, Division of Heart Failure, National Cerebral and Cardiovascular Center, Japan.

Journal of Cardiology
|August 5, 2023
PubMed

Insights

Selecting patients for transcatheter aortic valve replacement (TAVR) improves cost-effectiveness in Japan. This approach is more economical than TAVR for all patients, optimizing resource allocation for severe aortic stenosis treatment.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Interventional Cardiology

Background:

  • Severe symptomatic aortic stenosis (AS) requires treatment, but transcatheter aortic valve replacement (TAVR) benefits are not universal.
  • Investigating the cost-effectiveness of TAVR in a Japanese population is crucial for optimizing healthcare resource allocation.

Purpose of the Study:

  • To evaluate the cost-effectiveness of different TAVR strategies in a Japanese cohort with severe symptomatic AS.
  • To identify patient selection criteria that maximize the benefits of TAVR.

Main Methods:

  • A prospective multicenter study enrolled 110 symptomatic severe AS patients undergoing TAVR.
  • Quality of life (QOL) was assessed pre- and 6-months post-TAVR; non-responders were identified.
  • Three treatment models were simulated: conservative, TAVR for all, and TAVR for selected responders.

Main Results:

  • The TAVR for selected patients strategy yielded an incremental cost-effectiveness ratio (ICER) of 2,342,175 yen/QALY, below the 5,000,000 yen/QALY threshold.
  • The TAVR for all patients strategy had an ICER of 5,765,800 yen/QALY, exceeding the threshold.
  • Higher pre-TAVR QOL and clinical frailty scale predicted non-response.

Conclusions:

  • A TAVR strategy selecting likely responders is more cost-effective than treating all patients in Japan.
  • This selected patient approach optimizes TAVR benefits, particularly for frail individuals, and improves resource allocation.
  • This strategy supports directing interventions toward those most likely to experience improved quality of life.
Abstract

Keywords:
Cost effectiveness analysisProspective multicenter studyTranscatheter aortic valve replacement

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