Cost-Effectiveness of TAVR Compared With Clinical Surveillance in Patients with Asymptomatic Severe Aortic Stenosis in the United States

OBJECTIVES: The EARLY TAVR trial demonstrated improved clinical outcomes for patients with asymptomatic severe aortic stenosis (aSAS) treated with transcatheter aortic valve replacement (eTAVR) compared with clinical surveillance (CS). The cost-effectiveness of an eTAVR strategy for patients with aSAS in the United States is unknown. METHODS: A Markov model with 30-day cycles was developed from the US healthcare payor perspective to estimate the cost-effectiveness of eTAVR vs CS over a lifetime horizon. Inputs for population characteristics and health outcomes were derived from the EARLY TAVR trial. Costs were derived from US Medicare reimbursement rates. Probabilistic and deterministic sensitivity analyses were performed to evaluate the effect of parameter uncertainty on model output. RESULTS: When compared with CS, eTAVR was associated with 0.21 additional life-years (LY) and 0.24 additional quality-adjusted life-years over a lifetime because of more time spent in the alive and well health state with eTAVR. Lifetime costs were estimated to be $8812 lower, due primarily to reductions in costs associated with the AVR procedure, stroke, and heart failure hospitalizations. Accordingly, eTAVR was projected to be economically dominant over CS. In probabilistic sensitivity analysis, a large majority of iterations (95.9%) produced cost-effective results ($100 000 threshold) for eTAVR versus CS, with most simulations (90.3%) showing dominance, confirming the robustness of the base-case results. These findings were consistent over a variety of scenario analyses. CONCLUSIONS: An eTAVR strategy for the treatment of aSAS may be a cost-saving approach for US healthcare payors, when compared with CS.