Cost-Utility Analysis of TAVI Versus Surgery in Low-Risk Patients with Severe Aortic Stenosis in the UK
Year: 2025
Type: article
Abstract: BACKGROUND AND OBJECTIVE: European guidelines recommend transcatheter aortic valve implantation (TAVI; class IA) for symptomatic severe aortic stenosis (sSAS) in patients aged ≥ 75 years, if a transfemoral approach is possible. Recent cost-utility analyses based on the PARTNER 3 trial have suggested that TAVI with the SAPIEN 3 device is cost effective versus surgical aortic valve replacement (SAVR) in patients at low risk of surgical mortality in several European countries. This cost-utility analysis compares TAVI with SAPIEN 3 versus SAVR in patients with sSAS at low risk of surgical mortality from the UK healthcare system perspective, using 5-year PARTNER 3 trial data. METHODS: A two-stage, Markov-based, cost-utility analysis was performed using published and validated methodology to estimate changes in both direct healthcare costs and health-related quality of life for TAVI with SAPIEN 3 versus SAVR in patients with sSAS at low surgical risk from the perspective of the UK healthcare system. The model used a lifetime horizon with a 3.5% yearly discounting factor. Uncertainty was addressed using deterministic and probabilistic sensitivity analyses. RESULTS: Transcatheter aortic valve implantation with SAPIEN 3 generated an incremental health benefit of 0.47 (90% credible interval 0.35-0.60) quality-adjusted life-years per patient compared with SAVR, at an increased cost of £7999 (£852-£15,035 90% credible interval) per patient over a lifetime horizon (incremental cost-effectiveness ratio: £16,979 per quality-adjusted life-year gained). Transcatheter aortic valve implantation has a 63-90% probability of cost effectiveness based on a £20,000-£30,000 willingness-to-pay threshold. Transcatheter aortic valve implantation remained cost effective across most deterministic sensitivity analyses, confirming the relative robustness of the results. CONCLUSIONS: Transcatheter aortic valve implantation with SAPIEN 3 has a 63-90% probability of being cost effective compared with SAVR for low-surgical-risk patients with sSAS. These findings may inform policy decision making in the management of this patient group.
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,990
Funders: Edwards Lifesciences, University Hospital Southampton NHS Foundation Trust, University Hospitals Plymouth NHS Trust, National Institute for Health and Care Research, King's College London, University of Oxford, Oxford University Hospitals NHS Foundation Trust, NIHR Oxford Biomedical Research Centre
OpenAlex ID: W4416009534