番茄社区

For transcatheter aortic valve replacement (TAVR) to be a cost-effective choice over surgery in intermediate surgical-risk patients, it must demonstrate a survival benefit or substantially slash lengths of stay in the hospital, researchers argued.

If mortality rates are not reduced with , patients must then have hospital stays reduced by at least 5 days for their bioprostheses to be worth it in the long run, according to a model by , of Saint Luke's Mid America Heart Institute in Kansas City, Mo., and colleagues.

Each TAVR device currently carries a $30,000 price tag in the U.S. -- in comparison with the $5,000 for surgical aortic valve replacement (SAVR), they noted in their perspective piece published in Circulation.

"To understand the cost-effectiveness of TAVR in intermediate-risk patients, it is helpful to consider the lessons learned in higher-risk patients," the authors explained. "First, it is apparent that the major offsets for the increased technology cost of TAVR in comparison with SAVR are decreased hospital length of stay and a reduced need for postacute rehabilitation services."

Reductions in length of stay must be quite large for TAVR to pay for itself, they wrote, while suggesting that may be possible.

"As with most real advances in health care, current data suggest that, although the benefits of TAVR come at a price, these costs may be well justified. TAVR is a fast-moving field, with rapid improvements not only in technology, but also in patient selection, intraprocedural care, and avoidance of complications," Cohen's group concluded.

In the PARTNER 2A intermediate-risk cohort, there was no overall reduction in the combined endpoint of death or disabling stroke and the length of hospitalization was reduced by a median of 4 days compared with surgery. But for patients treated transfemorally, there was a trend toward reduced mortality at 2 years.

With the newer generation Sapien 3 valve in an intermediate-risk population study, the composite mortality or disabling stroke rate was lower than with either strategy in PARTNER 2A and the median length of stay was cut by 5 days compared with SAVR.

"The compelling clinical benefits of TAVR now demonstrated in intermediate-risk patients demand strong consideration for appropriate patients, particularly those suitable for transfemoral access. Just as previous data have suggested that TAVR is cost-effective in high-risk patients, preliminary data suggest that the health economic story of TAVR in intermediate-risk patients is likely to have a similar ending."

"Overall, I agree that, with what we know of TAVR's performance thus far, TAVR may not only provide tangible benefits in improved outcomes in regards to mortality and stroke but also provide these benefits with cost savings. Cost-effectiveness analyses, however, take on many assumptions and must be interpreted with this in mind," , of Emory University Hospital Midtown in Atlanta, told 番茄社区.

"As additional devices enter the market, TAVR procedures becomes further streamlined and efficient, and length of stay continues to decline, I expect cost-effectiveness to continue to move further in favor of TAVR over SAVR," Devireddy commented -- noting that this assumes that long-term durability of TAVR is demonstrated.

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