TAVR cost-saving vs. surgery in low-risk patients at 2 years
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In an economic analysis from the PARTNER 3 trial, transcatheter aortic valve replacement was economically dominant compared with surgery at 2 years in patients with severe aortic stenosis at low surgical risk.
TAVR has previously been demonstrated to be cost-effective in patients at intermediate or higher surgical risk, but few economic data were available on TAVR in patients at low surgical risk, David J. Cohen, MD, MSc, director of academic affairs at St. Francis Hospital and director of clinical and outcomes research at the Cardiovascular Research Foundation, said during a press conference at TCT 2021.
For the present analysis, Cohen and colleagues analyzed costs and quality-adjusted life-years related to the 929 U.S. patients who participated in the PARTNER 3 randomized trial of TAVR with a balloon-expandable valve (Sapien 3, Edwards Lifesciences) compared with surgical AVR in patients at low surgical risk. As Healio previously reported, in PARTNER 3, the TAVR group had a 37% reduced risk for the primary endpoint of death, stroke or rehospitalization at 2 years compared with the surgery group.
The index hospitalization costs were $47,196 for TAVR and $46,606 for surgery (difference, $591, P = .59), Cohen said during a press conference, noting the most of the costs in the TAVR group were related to the price of the device, whereas the surgery group had much greater nonprocedural costs due to longer length of stay and time in the ICU.
The 2-year follow-up costs were $19,638 in the TAVR group and $22,258 in the surgery group (difference, –$2,620; P = .13), with the TAVR group having much lower costs in the first 30 days, Cohen said.
Total 2-year costs were $66,834 in the TAVR group and $68,864 in the surgery group (difference, –$2,030; P = .31), he said.
In a base-case analysis, most scenarios had TAVR with lower costs and higher QALYs, Cohen said, noting the difference in cost was –$2,193, the difference in QALYs was 0.049, the probability of TAVR being economically dominant was 84% and the probability of TAVR being economically attractive was 95%.
TAVR was most economically dominant in patients with NYHA class III or IV HF (difference in cost, –$7,364; difference in QALYs, 0.124; probability of TAVR being economically attractive, 99%) and in patients with a Kansas City Cardiomyopathy Questionnaire overall summary score of less than 70 (difference in cost, –$6,012; difference in QALYs, 0.099; probability of TAVR being economically attractive, 96%), Cohen said.
He noted that the results could change based on long-term mortality. “Because the cost differences are relatively small, these results are very sensitive to differences in long-term mortality,” Cohen said. “The long-term mortality is going to be very critical to telling the final story here.”
Because of that, follow-up will continue out to 10 years, “and will ultimately determine the optimal treatment strategy for such patients from both a clinical and economic perspective,” Cohen said at the press conference.
Perspective
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Gilbert H. Tang, MD
The key message is that transfemoral TAVR is more cost-saving than surgical AVR at 2 years as long as there is no increased late mortality.
While transfemoral TAVR in the short term is more cost-effective than surgical AVR, we don’t know if there may be earlier valve reintervention or failure, making the overall treatment potentially more costly.
We need longer-term studies on TAVR cost-effectiveness, and to determine for which patients surgical AVR would be more cost-effective than TAVR, since in younger patients who receive TAVR, there may be an early cost savings, but pay a price later from earlier valve reintervention.
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Cohen DJ, et al. Late-Breaking Clinical Trials Session II, in Collaboration with JAMA. Presented at: TCT Scientific Symposium; Nov. 4-6, 2021; Orlando (hybrid meeting).
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