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Published on: March 26, 2018
Cost-Effectiveness of TAVI vs Minimally Invasive SAVR for Low-Risk Aortic Stenosis in Japan
Hiroshi Kawakami1, Taisuke Nakayama2, Ryo Miyabe1
1Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
Background:
Transcatheter aortic valve implantation (TAVI) and minimally invasive surgical aortic valve replacement (MICS-AVR) are both less invasive options for treating severe aortic stenosis (AS). However, most cost-effectiveness analyses have compared TAVI with conventional full-sternotomy surgery, and the economic value of TAVI relative to MICS-AVR under current surgical practice remains uncertain.
Objectives:
This study sought to assess the long-term cost-effectiveness of TAVI compared with MICS-AVR for patients with isolated severe AS from the Japanese health care payer's perspective.
Methods:
A decision analytical model was developed to evaluate long-term clinical and economic outcomes of TAVI and MICS-AVR. Model inputs were derived from randomized trials, meta-analyses, and Japanese national cost data. Incremental cost-effectiveness ratios (ICERs) were calculated in Japanese yen per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses tested model robustness, and a scenario analysis reflected outcomes from high-volume Japanese surgical centers. The willingness-to-pay threshold was set at ¥5 million per QALY.
Results:
In the base case, TAVI resulted in higher total costs (¥8.45 million vs ¥7.68 million) and slightly greater QALYs (6.55 vs 6.42), yielding an incremental cost-effectiveness ratio of ¥5,885,068 per QALY gained-marginally above the willingness-to-pay threshold, indicating that TAVI was not clearly cost-effective. In the high-volume surgical center scenario, MICS-AVR dominated TAVI, being both less costly and more effective.
Conclusions:
TAVI and MICS-AVR showed broadly comparable cost-effectiveness in low-risk patients with isolated severe AS. The relative economic value of TAVI depended strongly on institutional performance and surgical expertise.
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