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PARTNER B: Data reveal TAVR cost-competitive in elderly, inoperable patients
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American College of Cardiology 60th Annual Scientific Sessions
NEW ORLEANS – Transcatheter aortic valve replacement proved to be cost-effective when compared with standard care for patients with severe aortic stenosis who were not candidates for surgery, according to PARTNER cohort B data.
Researchers of the PARTNER trial randomly assigned patients (mean age, 83 years) to receive either transcatheter aortic valve replacement (TAVR; n=179) or standard non-surgical care (n=179) that included medication and balloon aortic valvuloplasty. They derived the one-year cost-effectiveness data on all patients from medical resource utilization data, as well as hospital billing for a sub-set of patients, and then projected long-term survival from this data.
Initially, the cost of TAVR, including care before and after the procedure, was roughly $78,000, with the cost of the system estimated at $30,000. During the first year, those in the standard care group were more than twice as likely to be hospitalized for CV reasons, which resulted in follow-up costs being $23,000 more expensive at one year when compared with the TAVR group, which partially offset initial costs of TAVR.
According to estimates, there was a gain in life expectancy of approximately 1.9 years with the TAVR approach (3.1 years vs. 1.2 years). Each year of life gained corresponded with an incremental cost-effectiveness ratio of roughly $50,200, or approximately $62,000 per each quality-adjusted life year gained.
In a press conference, Matthew R. Reynolds, MD, director, economics and quality of life research at Harvard Clinical Research Institute, Boston, explained that “These life-time projections are necessary to understand the return on the upfront investment because most of the cost is incurred at the beginning … Based on lifetime projections, we estimated an $8,000 difference for incremental cost associated with TAVR which is significant. We also estimated a survival gain which is also quite significant… of almost 2 years in this extremely high risk and elderly population.”
For more information:
- Reynolds M. LBCT I, Session 3010. Presented at: ACC 60th Annual Scientific Sessions; April 2-5, 2011; New Orleans.
Disclosures: Drs. Crawford and Reynolds report no relevant financial disclosures.
What is interesting is that right now there is a big upfront cost associated with [TAVR] in that you need a special room to do this in, one you can both do surgery and interventional procedures which are usually done in different rooms. Now you have to have what is called a “hybrid room” which has all the surgical and imaging things you need. There is a lot of cost in doing this not only with the facility, but the team, all the imaging techniques, so right now this can only be done in major centers that can assemble teams like this once it gets approved. It’s hopeful that as we gain experience with this technique this upfront cost will actually go down and the cost-effectiveness will get better because we may be able to trim off some of the imaging or maybe we won’t need an operating room anymore once the percutaneous technique gets perfected. So I see the costs going down over time.
– Michael H. Crawford, MD
Chief, Clinical Cardiology, Division of Cardiology,
University of California, San Francisco Medical Center
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