TOPLINE

Early transcatheter aortic valve implantation (TAVI) in patients with asymptomatic severe aortic stenosis (aSAS) was projected to lower lifetime healthcare costs while adding more quality-adjusted life years (QALYs) compared with clinical surveillance across nine European countries.

METHODOLOGY

• A cost-utility analysis compared early TAVI vs clinical surveillance in patients with asymptomatic severe aortic stenosis across nine European healthcare systems.
• A lifetime Markov model with a 30-day cycle length captured periprocedural and long-term outcomes across three health states: alive and well, stroke, and death, and estimated lifetime costs and QALYs.
• Clinical inputs were derived from the EARLY TAVR trial, which randomly assigned 901 patients with asymptomatic severe aortic stenosis to either early TAVI or clinical surveillance, with a median follow-up of 3.8 years.
• The cohort had a starting age of 75.8 years, with 69.1% male participants.
• Country-specific cost data for 2022/2023 were obtained from literature sources, including diagnostic-related groups and TAVI procedure funding, with costs inflated to 2022 values where necessary.

TAKEAWAY

• Early TAVI was economically dominant across all nine European healthcare systems, with cost-effectiveness probabilities ranging from 97.32% in the UK to 99.94% in Belgium.
• Incremental cost savings per person ranged from −£1788 in the UK to −CHF15,802 in Switzerland, with QALY gains of 0.18 in Germany and the UK to 0.23 in Switzerland.
• Early TAVI was linked to a reduction in total disabling strokes by 0.04-0.05 per person, total non-disabling strokes by 0.03 per person, and heart failure-related hospitalizations by 0.12-0.14 per person compared with clinical surveillance.
• Early TAVI was linked to an increase of 0.03-0.05 reinterventions per person but decreased new permanent pacemaker implantations by 0.03 per person across all countries; the median survival increased by 0.16-0.25 years.

IN PRACTICE

"[The] findings support policies and the growing body of evidence promoting the early detection of AS [aortic stenosis] and timely intervention before symptom onset, as opposed to providing CS [clinical surveillance] with a delayed AVR [aortic valve replacement] procedure," the authors of the study wrote.

SOURCE

The study was led by Philippe Genereux, MD, Morristown Medical Center, Gagnon Cardiovascular Institute in Morristown, New Jersey. It was published online on July 23 in European Heart Journal Open.

LIMITATIONS

The trial participants were aged ≥ 65 years, mostly White, and eligible for transfemoral TAVI with balloon-expandable valves, limiting generalizability. The model assumed only intermediate and high-surgical risk populations, which may have underestimated rates in patients at low risk.

DISCLOSURES

Several authors reported being employees of York Health Economics Consortium and were commissioned by Edwards Lifesciences to work on the model. Two authors reported being employees of Edwards Lifesciences. Multiple authors reported consulting fees, speaker fees, grants, or equity from Edwards Lifesciences and other medical device companies. Detailed disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.