Budget Analysis Details Economic Benefits of TAVR in Low-Risk Aortic Stenosis

Derrick Tam, MD, PhD

A new study is outlining not only the efficacy of TAVR compared with SAVR in patients with aortic stenosis, but also the monetary impact of either procedure among these patients.

Although a plethora of studies have outlined the benefits of TAVR compared with SAVR in patients with aortic stenosis, the results of the budget impact analysis provide new data demonstrating TAVR is an affordable and effective strategy for the treatment of aortic stenosis in low-risk patients.

“Although the cost-effectiveness of most transcatheter valve interventions is well studied, given the incremental costs associated with TAVR, the affordability from the hospital payer’s perspective was unknown,” explained coauthor Derrick Y. Tam, MD, PhD, Division of Cardiac Surgery, University of Toronto, in a statement. “As low-risk aortic stenosis patients likely represent the majority of severe AS patients requiring intervention, understanding the cost impact of treating more patients with TAVR becomes critically important for health policy and resource planning.”

In recent years, the expanding knowledge base related to the procedure has resulted in an increase in uptake of TAVR. However, despite the reductions in procedure-related outcomes and adverse events relative to SAVR, less research has been conducted related to the hospital-level impact of shifting loos-risk patients from SAVR to TAVR. With this in mind, investigators designed their study as a budget impact analysis with the intent of estimating 1-year total costs of treatment and management of low-risk aortic stenosis patients from a hospital payers’ perspective.

For the purpose of analysis, event rates and associated costs were obtained from published literature and provincial datasets. The primary outcomes of interest were the differences in cost per 100 patients based on different levels of TAVR uptake. Of note, all costs in the study were reported in 2021 Canadian dollars.

Upon analysis, investigators found the mean index hospitalization costs per patient were lower for the TAVR ($37,669) group than for the SAVR ($41,956) group. Results indicated the mean total costs of managing a low-risk aortic stenosis patient in 1 year for RTAVR and SAVR were $45,897 and $42,659, respectively. Further analysis suggested incremental budget impacts of increasing TAVR uptake from 10% to 50% and 70% were 3% and 4.5%, respectively. Investigators also pointed out that a 1-way sensitivity analysis provided evidence suggesting the main contributors to the cost difference were the intensive care unit stay, permanent pacemaker rate, and hospital length of stay.

“Traditionally, patients with severe AS were treated with SAVR through open heart surgery,” added coauthor Hamid Sadri, PharmD, MSc, MHSc, Medtronic Canada, Brampton, ON, Canada. “Because there is a perception that TAVR is expensive, hospital management often hesitates to increase funding for TAVR or reallocate some of the open-heart surgery funding to TAVR cases.”

In an accompanying editorial, Fiona Clement, PhD, and Derek Chew, MD, MSc, both of the Cumming School of Medicine, University of Calgary, commended investigators for their effort and note the potential impact of the work if the model were to be made openly available.

“This model represents a significant infrastructure. By making the model open access, the required investment of time and human resources need not be duplicated as decision-makers face similar questions about shifting from SAVR to TAVR. Further, the model can be responsive as science continues to develop,” wrote the pair.

This study, “Annual Budget Impact Analysis Comparing Self-Expanding Transcatheter and Surgical Aortic Valve Replacement in Low-Risk Aortic Stenosis Patients,” was published in the Canadian Journal of Cardiology.