Cost Effectiveness of Transcatheter Aortic Valve Implantation (TAVI) for Patients with Severe Symptomatic Aortic Stenosis in New Zealand

Background: Patients with severe symptomatic aortic stenosis face a poor prognosis unless they undergo surgical aortic valve replacement (SAVR), yet many are at high risk due to comorbidity, frailty or anatomical limitations. Clinically TAVI may be an appropriate alternative treatment; however, cost effectiveness requires careful consideration and will impact on funding. We aim to provide economic evidence and budget impact for the role for TAVI in the publically funded New Zealand health care system. Methods: Firstly, TAVI will be compared to SAVR with the assumption that health benefits to patients are neutral. Secondly, we will draw effectiveness parameters from the PARTNER trial. Finally, trend analysis of existing Auckland data will be used to test an efficient, contemporary TAVI production system. Cost analysis will be conducted using propensity score matching, supported by standard regression techniques. Results: Auckland District Health Board (ADHB) unit record data (n = 142) on characteristics and costs for patients undergoing TAVI and SAVR will be presented. Preliminary data suggest that cost of TAVI has fallen over time compared to SAVR. This appears to be due to a reduction in time spent in ICU and other reasons that will be discussed. The preliminary trend analysis suggests that better patient risk stratification, improved technique, increased clinical experience and enhanced procurement may further reduce cost and improve outcomes. Conclusions: We establish the current cost of TAVI to the public health system and highlight the importance of maintaining capacity for TAVI, to enable future expansion should the pathway for TAVI reduce in cost. CSANZ NZ AbstractsHeart, Lung and CirculationVol. 23Preview Full-Text PDF