Most of the world’s "affluent" healthcare systems are in agreement that transcatheter aortic valve implantation is an economically attractive options for inoperable patients, but there’s far less consensus on the cost-effectiveness of treating patients who are at high risk but still operable by clinical standards, according to a presentation delivered today at the 2013 Transcatheter Cardiovascular Therapeutics symposium in San Francisco.
The sticking point for economic benefit is the gain in quality of life, which is reportedly shorter for high-risk-operable patients than it is for inoperable patients, according to St. Luke’s Mid-America Heart Institute cardiovascular research director Dr. David Cohen.
Inoperable patients demonstrate a clear case for cost-savings, with studies from the U.S., Canada, Belgium and the U.K. generally agreeing that the cost per quality-of-life-year gained fits within payment expectations for the nations’ healthcare systems. The QALY costs for high-risk-operable patients, however, derives mostly from shorter hospital stays following the minimally invasive procedure in comparison to traditional open-heart surgery, and can be harder to justify.
"For inoperable patients, [TAVI] is clearly attractive, economically, by generally-set the standards in the U.S. and, frankly, also most other affluent healthcare systems such as western Europe, but it is critical to find patients who are going to benefit, who derive both quality of life benefit and who survive for at least 2-to-3 years in order to reap that benefit and justify the high cost of the initial procedure," Dr. Cohen said during today’s presentation. "For high risk but operable patients … it’s clear so far that TAVR offers only a short-term quality of life benefit compared with surgical AVR and therefore it has to be close to cost-neutral in order to be attractive."