Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis Results of the PARTNER (Placement of Aortic Transcatheter Valves) Trial (Cohort A)

被引：192

作者：

Reynolds, Matthew R. ^{[2
,3
]}

Magnuson, Elizabeth A.

Lei, Yang ^{[4
]}

Wang, Kaijun

Vilain, Katherine

Li, Haiyan

Walczak, Joshua ^{[2
]}

Pinto, Duane S. ^{[11
]}

Thourani, Vinod H. ^{[5
]}

Svensson, Lars G. ^{[6
]}

Mack, Michael J. ^{[7
]}

Miller, D. Craig ^{[8
]}

Satler, Lowell E. ^{[9
]}

Bavaria, Joseph ^{[10
]}

Smith, Craig R. ^{[12
]}

Leon, Martin B. ^{[12
]}

Cohen, David J. ^{[1
]}

机构：

[1] Univ Missouri, Sch Med, St Lukes Mid Amer Heart Inst, Kansas City, MO 64108 USA

[2] Harvard Clin Res Inst, Boston, MA USA

[3] Boston VA Healthcare Syst, Boston, MA USA

[4] Univ Kansas, Sch Med, Kansas City, KS USA

[5] Emory Univ, Sch Med, Atlanta, GA USA

[6] Cleveland Clin Fdn, Cleveland, OH 44195 USA

[7] Heart Hosp Baylor, Dallas, TX USA

[8] Stanford Univ, Palo Alto, CA 94304 USA

[9] Washington Hosp Ctr, Washington, DC 20010 USA

[10] Univ Penn, Philadelphia, PA 19104 USA

[11] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[12] Columbia Presbyterian Med Ctr, New York, NY USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2012年 / 60卷 / 25期

基金：

美国国家卫生研究院;

关键词：

aortic valve replacement; cost-effectiveness; TAVR; ECONOMIC-EVALUATION; CLINICAL-TRIAL; IMPLANTATION; OUTCOMES; ALONGSIDE; MODEL;

D O I：

10.1016/j.jacc.2012.09.018

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to evaluate the cost-effectiveness of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (AVR) for patients with severe aortic stenosis and high surgical risk. Background TAVR is an alternative to AVR for patients with severe aortic stenosis and high surgical risk. Methods We performed a formal economic analysis based on cost, quality of life, and survival data collected in the PARTNER A (Placement of Aortic Transcatheter Valves) trial in which patients with severe aortic stenosis and high surgical risk were randomized to TAVR or AVR. Cumulative 12-month costs (assessed from a U. S. societal perspective) and quality-adjusted life-years (QALYs) were compared separately for the transfemoral (TF) and transapical (TA) cohorts. Results Although 12-month costs and QALYs were similar for TAVR and AVR in the overall population, there were important differences when results were stratified by access site. In the TF cohort, total 12-month costs were slightly lower with TAVR and QALYs were slightly higher such that TF-TAVR was economically dominant compared with AVR in the base case and economically attractive (incremental cost-effectiveness ratio <$50,000/QALY) in 70.9% of bootstrap replicates. In the TA cohort, 12-month costs remained substantially higher with TAVR, whereas QALYs tended to be lower such that TA-TAVR was economically dominated by AVR in the base case and economically attractive in only 7.1% of replicates. Conclusions In the PARTNER trial, TAVR was an economically attractive strategy compared with AVR for patients suitable for TF access. Future studies are necessary to determine whether improved experience and outcomes with TA-TAVR can improve its cost-effectiveness relative to AVR. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894) (J Am Coll Cardiol 2012;60:2683-92) (C) 2012 by the American College of Cardiology Foundation

引用

页码：2683 / 2692

页数：10

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