PMID- 35927703
OWN - NLM
STAT- MEDLINE
DCOM- 20220808
LR  - 20220808
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 22
IP  - 1
DP  - 2022 Aug 4
TI  - Cost-effectiveness of transcatheter aortic valve implantation in patients with 
      severe symptomatic aortic stenosis of intermediate surgical risk in Singapore.
PG  - 994
LID - 10.1186/s12913-022-08369-5 [doi]
LID - 994
AB  - OBJECTIVE: The objective was to assess the cost-effectiveness of transcatheter 
      aortic valve implantation (TAVI) in patients with severe aortic stenosis with 
      intermediate surgical risk in Singapore. METHODS: A de novo Markov model with 
      three health states - stroke with long-term sequelae, no stroke, and death - was 
      developed and simulated using Monte Carlo simulations with 10,000 iterations over 
      a five-year time horizon from the Singapore healthcare system perspective. A 3% 
      annual discount rate for costs and outcomes and monthly cycle lengths were used. 
      By applying the longest available published clinical evidence, simulated patients 
      received either TAVI or surgical aortic valve replacement (SAVR) and were at risk 
      of adverse events (AEs) such as moderate-to-severe paravalvular aortic 
      regurgitation (PAR). RESULTS: When five-year PARTNER 2A data was applied, 
      base-case analyses showed that the incremental cost-effectiveness ratio (ICER) 
      for TAVI compared to SAVR was US$315,760 per quality-adjusted life year (QALY) 
      gained. The high ICER was due to high incremental implantation and procedure 
      costs of TAVI compared to SAVR, and marginal improvement of 0.10 QALYs as 
      simulated mortality of TAVI exceeded SAVR at 3.75 years post-implantation. 
      One-way sensitivity analysis showed that the ICERs were most sensitive to cost of 
      PAR, utility values of SAVR patients, and cost of TAVI and SAVR implants and 
      procedures. When disutilities for AEs were additionally applied, the ICER 
      decreased to US$300,070 per QALY gained. TAVI was dominated by SAVR when the time 
      horizon increased to 20 years. Clinical outcomes projected from one-year PARTNER 
      S3i data further reduced the ICER to US$86,337 per QALY gained for TAVI, assuming 
      early all-cause mortality benefits from TAVI continued to persist. This 
      assumption was undermined when longer term data showed that TAVI's early 
      mortality benefits diminished at five years. LIMITATIONS AND CONCLUSION: TAVI is 
      unlikely to be cost-effective in intermediate surgical-risk patients compared to 
      SAVR in Singapore.
CI  - (c) 2022. The Author(s).
FAU - See-Toh, Rachel Su-En
AU  - See-Toh RS
AD  - Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore.
FAU - Wong, Xin Yi
AU  - Wong XY
AD  - Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore.
FAU - Mahboobani, Kush Shiv Kishore Herkshin
AU  - Mahboobani KSKH
AD  - Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore.
FAU - Soon, Swee Sung
AU  - Soon SS
AD  - Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore.
FAU - Kearns, Benjamin
AU  - Kearns B
AD  - School of Health and Related Research, University of Sheffield, Sheffield, UK.
FAU - Cooper, Katy
AU  - Cooper K
AD  - School of Health and Related Research, University of Sheffield, Sheffield, UK.
FAU - Ho, Kay Woon
AU  - Ho KW
AD  - National Heart Centre, Singapore, Singapore.
FAU - Kuntjoro, Ivandito
AU  - Kuntjoro I
AD  - National University Heart Centre, Singapore, Singapore.
FAU - Ng, Kwong
AU  - Ng K
AD  - Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore. 
      ng_kwong_hoe@moh.gov.sg.
LA  - eng
PT  - Journal Article
DEP - 20220804
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
MH  - *Aortic Valve Stenosis/surgery
MH  - Cost-Benefit Analysis
MH  - *Heart Valve Prosthesis Implantation/adverse effects/methods
MH  - Humans
MH  - Risk Factors
MH  - Singapore/epidemiology
MH  - *Transcatheter Aortic Valve Replacement/adverse effects
MH  - Treatment Outcome
PMC - PMC9354430
OTO - NOTNLM
OT  - Cost-effectiveness
OT  - Singapore
OT  - TAVI
OT  - TAVR
OT  - Transcatheter aortic valve implantation
OT  - Transcatheter aortic valve replacement
COIS- H.K. and I.K. received honoraria as speakers from Edwards Lifesciences and 
      Medtronic. All other authors declared no competing interests.
EDAT- 2022/08/05 06:00
MHDA- 2022/08/09 06:00
PMCR- 2022/08/04
CRDT- 2022/08/04 23:47
PHST- 2022/01/03 00:00 [received]
PHST- 2022/07/18 00:00 [accepted]
PHST- 2022/08/04 23:47 [entrez]
PHST- 2022/08/05 06:00 [pubmed]
PHST- 2022/08/09 06:00 [medline]
PHST- 2022/08/04 00:00 [pmc-release]
AID - 10.1186/s12913-022-08369-5 [pii]
AID - 8369 [pii]
AID - 10.1186/s12913-022-08369-5 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2022 Aug 4;22(1):994. doi: 10.1186/s12913-022-08369-5.