Valvular & structural heart disease

Economic Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Low Surgical Risk: Results from the PARTNER 3 Trial

CirculationPublished Economic evaluation (cost-effectiveness analysis) of the PARTNER 3 randomised trial

Authors' conclusion

For patients with severe aortic stenosis and low surgical risk similar to those enrolled in the PARTNER 3 trial, transfemoral TAVR with the SAPIEN 3 valve is cost saving compared with SAVR at 2 years and is projected to be economically attractive in the long run as long as there are no substantial differences in late death between the 2 strategies.

Study context

Population
Patients with severe aortic stenosis at low surgical risk who underwent valve replacement, enrolled in the USof 1000 randomised
Participants
929 patients
Comparison
Transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR)
Primary endpoint
Cost per quality-adjusted life-year gained (lifetime cost-effectiveness)
Methodological detailseconomic substudy, Markov model, US health care system perspective, lifetime horizon
  • Economic substudy
  • Markov model
  • US health care system perspective
  • Lifetime horizon

Primary result

As reported in the abstract

2-year costs and quality-adjusted life-years

Cost savings

$2030 per patient

95% CI -$6222 to $1816

TAVR

Gain

0.05 quality-adjusted life-years (95% CI −0.003 to 0.102)

TAVR

Base case: TAVR projected economically dominant; probability ICER <$50 000/QALY gained
95%

Further findings

Index costs

Procedural costs higher with TAVR
nearly $19 000
Total index hospitalization costs higher with TAVR
$591

Sensitivity to long-term survival

A modest long-term survival advantage with SAVR would render SAVR cost-effective (not cost saving) vs TAVR

Original publication

Economic Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Low Surgical Risk: Results from the PARTNER 3 Trial. Circulation. Published 8 May 2023. doi:10.1161/circulationaha.122.062481

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