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Rigshospitalet - a part of Copenhagen University Hospital
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Cost-effectiveness of transcatheter versus surgical aortic valve replacement in patients at lower surgical risk: results from the NOTION trial

Research output: Contribution to journalJournal articleResearchpeer-review

DOI

  1. Feasibility and safety of transcaval transcatheter aortic valve implantation: a multicentre European registry

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Impact of implant depth on hydrodynamic function of the ALLEGRA bioprosthesis in valve-in-valve interventions

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  3. The role of the Heart Team in the planning of aortic valve replacement

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  4. Will the Evolut Low Risk trial change my practice?

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  5. Durability of transcatheter bioprosthetic aortic valves: the story so far

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  1. Cardiovascular complications in patients with total cavopulmonary connection: A nationwide cohort study

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  2. Intravascular iliac artery lithotripsy to enable transfemoral thoracic endovascular aortic repair

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  3. Feasibility and safety of transcaval transcatheter aortic valve implantation: a multicentre European registry

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Impact of implant depth on hydrodynamic function of the ALLEGRA bioprosthesis in valve-in-valve interventions

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Outcome after heart-lung or lung transplantation in patients with Eisenmenger syndrome

    Research output: Contribution to journalJournal articleResearchpeer-review

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AIMS: The aim of this study was to estimate the cost-effectiveness of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in patients at lower surgical risk.

METHODS AND RESULTS: Discounted costs from a societal perspective and effectiveness as quality-adjusted life years (QALYs) were projected to lifetime via a decision-analytic model calibrated to 60-month data from the NOTION trial. The base case assumed a scenario in which any mortality benefit would gradually fade out over time, with other scenarios explored in sensitivity analyses. The incremental cost-effectiveness ratio (ICER) was compared to the country-specific willingness-to-pay (WTP) threshold of 1.13 million Danish kroner (DKK). The base case ICER was DKK 696,264/QALY (around €72,100/QALY via purchasing parity adjustment). Variation in long-term mortality beyond five years led to limited variation of incremental costs (DKK 64,200 to 64,600), but a more pronounced variation in incremental QALYs (0.07 to 0.19 QALYs for most conservative and optimistic assumptions, compared to base case of 0.09 QALYs). All resulting ICERs (range DKK 334,200 to DKK 904,100 per QALY gained) were below the WTP threshold.

CONCLUSIONS: TAVI in a cohort of primarily low surgical risk patients was found to be a cost-effective treatment strategy in the Danish healthcare system. Cost-effectiveness analyses in other settings are warranted as are registries given the sensitivity of the model to long-term mortality.

Original languageEnglish
JournalEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Volume15
Issue number11
Pages (from-to)e959-e967
ISSN1774-024X
DOIs
Publication statusPublished - 6 Dec 2019

    Research areas

  • Aortic Valve, Aortic Valve Stenosis, Cost-Benefit Analysis, Heart Valve Prosthesis, Humans, Quality-Adjusted Life Years, Transcatheter Aortic Valve Replacement

ID: 59143109