Transcatheter aortic valve implantation against conventional aortic valve replacement surgery in high-risk patients with aortic stenosis : a cost-effectiveness analysis

Background Aortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in fnancial resources, it is crucial to investigate the cost-efectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-efectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery. Methods This study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran’s national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty. Results The incremental cost, efectiveness, and cost-efectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$ 1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-efective at one and three times the country’s Gross Domestic Production (GDP) is 0.31 and 0.83, respectively. Conclusions TAVI does not seem a cost-efective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-efective will raise to 83%.