Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden
Background: Transcatheter aortic valve implantation (TAVI) has shown similar or improved clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis at low risk for surgical mortality. This cost-utility analysis compared TAVI with SAPI...
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Upsala Medical Society
2025-04-01
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| Series: | Upsala Journal of Medical Sciences |
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| Online Access: | https://ujms.net/index.php/ujms/article/view/10741/19351 |
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| author | Konrad Nilsson Stefan James Oskar Angerås Jenny Backes Henrik Bjursten Pascal Candolfi Mattias Götberg Henrik Hagström Chiara Malmberg Niels Erik Nielsen Archita Sarmah Magnus Settergren Tom Bromilow |
| author_facet | Konrad Nilsson Stefan James Oskar Angerås Jenny Backes Henrik Bjursten Pascal Candolfi Mattias Götberg Henrik Hagström Chiara Malmberg Niels Erik Nielsen Archita Sarmah Magnus Settergren Tom Bromilow |
| author_sort | Konrad Nilsson |
| collection | DOAJ |
| description | Background: Transcatheter aortic valve implantation (TAVI) has shown similar or improved clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis at low risk for surgical mortality. This cost-utility analysis compared TAVI with SAPIEN 3 versus SAVR in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of the Swedish healthcare system. Methods: A published, two-stage, Markov-based cost-utility model that captured clinical outcomes from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated according to Recommended Therapies (SWEDEHEART) registry (2018–2020) was adapted from the perspective of the Swedish healthcare system using local general population mortality, utility and costs data. The model had a lifetime horizon. Model outputs included changes in direct healthcare costs and health-related quality of life from using TAVI as compared with SAVR. Results: TAVI with SAPIEN 3 resulted in lifetime costs per patient of 484,142 SEK Swedish krona (SEK) and lifetime quality-adjusted life years (QALYs) per patient of 7.16, whilst SAVR resulted in lifetime costs and QALYs per patient of 457,625 SEK and 6.81 QALYs, respectively. Compared with SAVR, TAVI offered an incremental improvement of +0.35 QALY per patient at an increased cost of +26,517 SEK per patient over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of 76,532 SEK per QALY gained. Conclusion: TAVI with SAPIEN 3 is a cost-effective option versus SAVR for patients with symptomatic severe aortic stenosis at low risk for surgical mortality treated in the Swedish healthcare setting. These findings may inform policy decisions in Sweden for the management of this patient group. |
| format | Article |
| id | doaj-art-9738f3f31c624c7ba1dd75c0f01a93c6 |
| institution | DOAJ |
| issn | 0300-9734 2000-1967 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Upsala Medical Society |
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| series | Upsala Journal of Medical Sciences |
| spelling | doaj-art-9738f3f31c624c7ba1dd75c0f01a93c62025-08-20T03:14:05ZengUpsala Medical SocietyUpsala Journal of Medical Sciences0300-97342000-19672025-04-0113011010.48101/ujms.v130.1074110741Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in SwedenKonrad Nilsson0Stefan James1Oskar Angerås2Jenny Backes3Henrik Bjursten4Pascal Candolfi5Mattias Götberg6Henrik Hagström7Chiara Malmberg8Niels Erik Nielsen9Archita Sarmah10Magnus Settergren11Tom Bromilow12Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, SwedenDepartment of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, SwedenDepartment of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, SwedenDepartment of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, SwedenDepartment of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Lund University, Lund, SwedenEdwards Lifesciences SA, Nyon, SwitzerlandDepartment of Cardiology, Skåne University Hospital, Clinical Sciences, Lund University, Lund, SwedenDepartment of Public Health and Clinical Medicine, Umeå University, Umeå, SwedenIHE – The Swedish Institute for Health Economics, Stockholm, SwedenDepartment of Cardiology, Heart Centre, University Hospital, Linköping, SwedenEdwards Lifesciences SA, Nyon, SwitzerlandHeart and Vascular Unit, Karolinska University Hospital, Stockholm, SwedenYork Health Economics Consortium, University of York, York, UKBackground: Transcatheter aortic valve implantation (TAVI) has shown similar or improved clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis at low risk for surgical mortality. This cost-utility analysis compared TAVI with SAPIEN 3 versus SAVR in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of the Swedish healthcare system. Methods: A published, two-stage, Markov-based cost-utility model that captured clinical outcomes from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated according to Recommended Therapies (SWEDEHEART) registry (2018–2020) was adapted from the perspective of the Swedish healthcare system using local general population mortality, utility and costs data. The model had a lifetime horizon. Model outputs included changes in direct healthcare costs and health-related quality of life from using TAVI as compared with SAVR. Results: TAVI with SAPIEN 3 resulted in lifetime costs per patient of 484,142 SEK Swedish krona (SEK) and lifetime quality-adjusted life years (QALYs) per patient of 7.16, whilst SAVR resulted in lifetime costs and QALYs per patient of 457,625 SEK and 6.81 QALYs, respectively. Compared with SAVR, TAVI offered an incremental improvement of +0.35 QALY per patient at an increased cost of +26,517 SEK per patient over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of 76,532 SEK per QALY gained. Conclusion: TAVI with SAPIEN 3 is a cost-effective option versus SAVR for patients with symptomatic severe aortic stenosis at low risk for surgical mortality treated in the Swedish healthcare setting. These findings may inform policy decisions in Sweden for the management of this patient group.https://ujms.net/index.php/ujms/article/view/10741/19351transcatheter aortic valve implantationsurgical aortic valve replacementcost-effectivenessaortic stenosislow risk |
| spellingShingle | Konrad Nilsson Stefan James Oskar Angerås Jenny Backes Henrik Bjursten Pascal Candolfi Mattias Götberg Henrik Hagström Chiara Malmberg Niels Erik Nielsen Archita Sarmah Magnus Settergren Tom Bromilow Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden Upsala Journal of Medical Sciences transcatheter aortic valve implantation surgical aortic valve replacement cost-effectiveness aortic stenosis low risk |
| title | Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden |
| title_full | Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden |
| title_fullStr | Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden |
| title_full_unstemmed | Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden |
| title_short | Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden |
| title_sort | cost effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in sweden |
| topic | transcatheter aortic valve implantation surgical aortic valve replacement cost-effectiveness aortic stenosis low risk |
| url | https://ujms.net/index.php/ujms/article/view/10741/19351 |
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