Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Risk Results From the PARTNER 2 Trial
Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Risk Results From the PARTNER 2 Trial
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DOI：
10.1161/circulationaha.118.035236
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发表时间：
2019-02-12
期刊：
影响因子：
37.8
通讯作者：
Cohen, David J.
中科院分区：
文献类型：
--
作者：
Baron, Suzanne J.;Wang, Kaijun;Cohen, David J.
背景技术背景：在中度手术风险的重度主动脉瓣狭窄（AS）患者中，经导管主动脉瓣置换术（TAVR）或外科主动脉瓣置换术（SAVR）治疗导致2年时死亡或卒中的发生率相似。TAVR与SAVR相比是否对中度风险患者具有成本效益仍不确定。方法：2011年至2014年，PARTNER 2试验（主动脉经导管瓣膜置入2）中，3110例中度风险AS患者接受了TAVR或SAVR治疗。在PARTNER 2A试验中，共有2032例患者随机接受使用SAPIEN XT瓣膜（XT-TAVR）或SAVR进行的TAVR，而PARTNER S3 i登记研究纳入了另外1078例使用SAPIEN 3瓣膜（S3-TAVR）进行TAVR治疗的患者，与XT-TAVR相比，SAPIEN 3瓣膜具有更低的输送外径和密封裙缘，旨在减少瓣周返流。使用测量的资源利用率估计手术成本。其他试验期间费用通过试验数据与医疗保险索赔（n=2333）的联系或未联系患者（n=682）的线性回归模型进行评估。使用EQ-5D估计基线和1、12和24个月时的健康效用。使用马尔可夫模型告知在试验中的成本，公用事业，和生存数据，从美国医疗保健系统的角度来看，终身成本效益估计的每质量调整生命年获得的成本。结果：尽管TAVR的手术费用比SAVR高出约20000美元，XT-TAVR组的指数住院总成本差异仅高出2888美元（P=0.014），S3-TAVR组低出4155美元（P
BACKGROUND: In patients with severe aortic stenosis (AS) at intermediate surgical risk, treatment with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) results in similar rates of death or stroke at 2 years. Whether TAVR is cost-effective compared with SAVR for intermediaterisk patients remains uncertain.METHODS: Between 2011 and 2014, 3110 intermediate-risk AS patients were treated with TAVR or SAVR in the PARTNER 2 trial (Placement of Aortic Transcatheter Valves 2). A total of 2032 patients were randomized to receive TAVR using the SAPIEN XT valve (XT-TAVR) or SAVR in the PARTNER 2A trial, whereas the PARTNER S3i registry included an additional 1078 patients treated with TAVR using the SAPIEN 3 valve (S3-TAVR), which offers a lower delivery profile and sealing skirt designed to reduce paravalvular regurgitation compared with XT-TAVR. Procedural costs were estimated using measured resource utilization. Other in-trial costs were assessed by linkage of trial data with Medicare claims (n=2333) or by linear regression models for unlinked patients (n=682). Health utilities were estimated using the EQ-5D at baseline and 1, 12, and 24 months. Using a Markov model informed by in-trial costs, utilities, and survival data, lifetime cost-effectiveness from the perspective of the US healthcare system was estimated in terms of cost per quality-adjusted life-year gained.RESULTS: Although procedural costs were approximate to$20 000 higher with TAVR than SAVR, total cost differences for the index hospitalization were only $2888 higher with XT-TAVR (P=0.014) and were $4155 lower with S3-TAVR (P