Transfemoral TAVI Economic Outcomes “Remarkably Positive For A Relatively New Technology”. Transapical TAVI Not So.

In short

A new study, released on the online version of the Journal of the American College of Cardiology has concluded that TAVI (or TAVR, your choice) was an economically attractive strategy compared with surgical Aortic Valve Replacement (AVR) for patients suitable for Transfemoral (TF) access.

Background

The paper, published in early November, can be found here. It’s an interesting read and summarises interim findings from the PARTNER A and B trials, evaluating use of Edwards Lifesciences Sapien valve on the basis of clinical outcome, cost effectiveness and quality of life(QOL). In a nutshell, PARTNER B data suggests that for patients with severe aortic stenosis who are considered inoperable by conventional surgical methods, TAVI is better in terms of survival and quality of life than the alternative non surgical treatment.

In the other study, so-called PARTNER A, which looked at patients considered operable by conventional surgery, but at high risk, comparisons were made between surgery and TAVI using transfemoral or transapical approaches. The data suggests that clinical outcomes in terms of survival were similar between surgery and TF TAVI in time points up to 2 years, although quality of life was better in the TAVI group initially, and equivalent to surgery after 6 months. The transapical group didn’t fare as well on these measures. Indeed the study went on to assess cost-effectiveness in the high risk group and again found the transapical approach to be less easily justified on economic grounds than the transfemoral approach, which it says is sufficiently similar that┬áneither therapy would be clearly preferred over the other on health economic grounds.

The report concludes that for Transapical TAVR to become a cost-effective alternative to AVR at current valve acquisition costs, it will be necessary to demonstrate substantial reductions in postoperative length of stay as well as early QOL outcomes that are at least as good as (or better than) those achieved with surgical AVR. Alternatively the valve price would need to be $15K less, putting into perspective the cost of these things compared with conventionally inserted heart valves ($30k vs $5k).

Source: Journal of the American College of Cardiology