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Expected Survival and Value of Transcatheter Aortic Valve Implantation (TAVI) Versus Medical Therapy in Patients with Severe Aortic Stenosis (AS) Based on the Flinders Medical Centre (FMC) Comparative Dataset

2011; Elsevier BV; Volume: 20; Linguagem: Inglês

10.1016/j.hlc.2011.05.311

1444-2892

R. Prakash, Derek P. Chew, Ajay Sinhal, Matthew Horsfall, C. Green, D. Makoy, Jayme Bennetts, A. Markwick, J. Judd, K. Waddell-Smith, Yee Weng Wong,

Infective Endocarditis Diagnosis and Management

Background: TAVI is a rapidly emerging modality for aortic valve replacement among the elderly with significant comorbidities. Its high cost remains a considerable limitation. Objective: The impact of patient's expected survival on the economic value of TAVI was examined. Methods: Patients with severe AS were identified from the FMC echocardiographic database excluding known dementia, CVA, malignancies and prior valve surgery. Survival status and death were determined by clinical followup and interrogation of state-based clinical records repository. Survival beyond observed data were calculated using a Royston-Parmar model adjusted for age, renal impairment, Charlson index and LV function. Predetermined hospital costs, prosthesis, ICU, ward stay, investigations and recurrent CCF admissions were used. Estimates of cost effectiveness were calculated by differential survival and costs between TAVI patients and medically managed patients throughout four years using the Monte-Carlo simulation. Results: 538 patients with severe AS were identified. Fifty-six patients underwent TAVI in FMC. Median age was 85.25 years (i.q.r. 80.0–90.0 years). Unadjusted hazard ratio with TAVI (0.46, 95% CI 0.24–0.89, p = 0.022) was greater than observed in PARTNERS (HR, 0.55) but this benefit diminished after adjusting for comorbidities, (0.64, 95% CI 0.31–1.35, p = NS). Estimated cost for TAVI in the first year was ∼$80,000. Estimated cost per life saved over four years was $71,788 (±$50,891). Conclusion: Current costing suggests the expected survival of patients independent of severe AS needs to exceed four years for TAVI to be economically attractive when considering survival alone. Quality of life considered, this survival threshold may be shortened.