TAVR Found to Be Cost-Effective Compared With SAVR in Intermediate-Risk Patients With Aortic Stenosis
October 31, 2017—Analysis of the PARTNER IIA trial and the SAPIEN 3 intermediate-risk registry found transcatheter aortic valve replacement (TAVR) to be highly cost-effective compared with surgical aortic valve replacement (SAVR) in patients at intermediate surgical risk with aortic stenosis. The findings were reported at TCT 2017, the 29th annual Transcatheter Cardiovascular Therapeutics scientific symposium being held October 30 to November 2 in Denver, Colorado.
The investigators used data from the PARTNER IIA randomized trial and the SAPIEN 3 intermediate-risk registry to perform a formal, patient-level, economic analysis comparing TAVR using either the Sapien XT valve (XT-TAVR; Edwards Lifesciences) or the Sapien 3 valve (S3-TAVR; Edwards Lifesciences) with SAVR. The PARTNER IIA and SAPIEN 3 cost-effectiveness trial was funded by Edwards Lifesciences.
The comparison between XT-TAVR and SAVR was based on randomized assignment within PARTNER IIA; the comparison between S3-TAVR and SAVR was not randomized. Procedural costs were assessed based on measured resource utilization, and all other costs were assessed by linking trial data with Medicare claims for the index hospitalization and follow-up period or by piecewise regression models for the remaining patients.
The TCT announcement summarized the findings from the PARTNER IIA and SAPIEN 3 as follows.
In the PARTNER IIA trial, XT-TAVR led to significant reductions in procedure duration compared with SAVR (102 ± 46 min vs 236 ± 83 min; P < .001) and hospital length of stay (6.4 ± 5.5 days vs 10.9 ± 7.6 days; P < .001).
Although procedural costs were $22,083 higher with XT-TAVR than SAVR (reflecting the higher cost of the transcatheter valve), most of this higher cost was offset by reduced costs related to length of hosptial stay and in-hospital complications such that total costs for the index hospitalization were only approximately $2,900 higher with TAVR ($61,433 vs $58,545; P = .014).
During the following 24 months, follow-up costs were substantially lower with XT-TAVR (by $9,303 per patient) such that total medical care costs were lower with TAVR than SAVR 2-year follow-up ($107,716 vs $114,132; P = .014). When the trial results were projected over a lifetime horizon, XT-TAVR was projected to result in both cost savings of $7,949 and greater quality-adjusted life expectancy (by 0.15 years).
When performance of S3-TAVR in the S3i registry was compared with SAVR within PARTNER IIA, the reductions in procedure duration (84 ± 38 min vs 236 ± 83 min; P < .001) and length of stay (4.6 ± 5.7 days vs 10.9 ± 7.6 days; P < .001) were even greater than in the randomized trial.
As a result, despite the higher cost of the transcatheter valve, total costs for the index hospitalization were lower with S3-TAVR than SAVR ($54,256 vs $58,410; P = .014).
During the first year of follow-up, S3-TAVR resulted in additional cost savings of approximately $11,000 per patient.
When these in-trial results (including improved survival at 2 years) were projected over a lifetime horizon, S3-TAVR was projected to yield lifetime cost savings of $9,692 per patient and a significant gain in quality adjusted life-years (0.27 years)—an economically dominant strategy.
David J. Cohen, MD, who led the investigation, commented in the TCT announcement, “For patients with severe aortic stenosis and intermediate surgical risk similar to those enrolled in the PARTNER II trial, these results demonstrating substantial cost savings and improved quality-adjusted life expectancy, indicate that transcatheter aortic valve replacement should be considered the preferred strategy based on both clinical and economic considerations,” Dr. Cohen is Director of Cardiovascular Research at Saint Luke's Mid America Heart Institute in Kansas City, Missouri.