Cost-effectiveness of population screening for aortic stenosis

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Geriatrics

Background:

• Aortic stenosis (AS) is a progressive condition in the elderly, leading to significant morbidity and mortality.
• Aortic valve replacement is the only effective treatment for AS.
• The cost-effectiveness of AS screening in Canadian geriatric populations is not well-established.

Purpose of the Study:

• To determine the cost-effectiveness of screening for aortic stenosis (AS) using transthoracic echocardiography (TTE).
• To evaluate screening in a geriatric population within Canada's publicly funded healthcare system.

Main Methods:

• Markov models were used to estimate the incremental cost-effectiveness ratio (ICER).
• The model incorporated health states for diagnosed/undiagnosed AS, hospitalizations, and transcatheter aortic valve replacement (TAVR).
• Simulations included screening at ages 70 and 80, with a lifetime horizon and 1.5% discount rate.

Main Results:

• Screening for AS at age 80 yielded an ICER of $28,005 per QALY, considered cost-effective at a willingness-to-pay of $50,000.
• Screening at age 70 had a higher ICER of $156,722.
• Early intervention for asymptomatic severe AS was not cost-effective in scenario analyses.

Conclusions:

• One-time TTE screening for AS at age 80 is cost-effective in Canada.
• This screening strategy improves quality of life for the geriatric population.
• Cost-effectiveness is contingent on reserving TAVR for symptomatic patients.