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Cost-Effectiveness of Aortic Valve Replacement in Low- and Intermediate-Risk Chinese Patients With Severe Aortic

Jin Peng1,2,3,4, Xinglong Zheng5, Minghuan Jiang1,2,3,4,6

  • 1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy (J.P., M.J., X.Y., Y.M., M.F., Y.F.), Xi'an Jiaotong University, China.

Circulation. Cardiovascular Quality and Outcomes
|March 18, 2025
PubMed

Insights

In China, neither universal Transcatheter Aortic Valve Replacement (TAVR) nor a risk-based strategy is cost-effective for severe aortic stenosis patients compared to Surgical Aortic Valve Replacement (SAVR). Universal SAVR remains the most cost-effective approach for these patient groups.

Area of Science:

  • Cardiology
  • Health Economics
  • Medical Technology Assessment

Background:

  • Transcatheter Aortic Valve Replacement (TAVR) is debated as an alternative to Surgical Aortic Valve Replacement (SAVR).
  • Severe aortic stenosis management requires evaluating cost-effectiveness, especially in diverse healthcare systems like China's.
  • Risk stratification is crucial for optimizing treatment strategies in aortic stenosis.

Purpose of the Study:

  • To evaluate the cost-effectiveness of TAVR versus SAVR in low- and intermediate-risk patients with severe aortic stenosis in China.
  • To compare universal SAVR, universal TAVR, and a risk-based strategy (SAVR for low-risk, TAVR for intermediate-risk).
  • To determine the most economically viable aortic valve replacement strategy within the Chinese healthcare context.

Main Methods:

  • A decision-analytic model combining decision tree and Markov model was employed.
  • Clinical inputs were derived from meta-analysis; cost data utilized Shaanxi Province claims (2019-2021); quality of life measured by EuroQoL-5D.
  • Sensitivity analyses (one-way and probabilistic Monte Carlo simulations) assessed model robustness.

Main Results:

  • Universal TAVR yielded the most Quality-Adjusted Life-Years (QALYs) but incurred the highest costs.
  • The risk-based strategy and universal TAVR exceeded the willingness-to-pay threshold compared to universal SAVR.
  • Universal SAVR demonstrated an 89.81% probability of being cost-effective, significantly higher than TAVR strategies.

Conclusions:

  • Neither the risk-based strategy nor universal TAVR is cost-effective compared to universal SAVR for low- and intermediate-risk patients in China.
  • Universal SAVR remains the preferred cost-effective strategy for severe aortic stenosis in this population.
  • Significant reductions in TAVR valve costs could potentially alter cost-effectiveness findings.
Abstract

Keywords:
Monte Carlo methodaortic valve stenosiscost-benefit analysisquality-adjusted life yearstranscatheter aortic valve replacement

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