Vicente Serra

Transfemoral transcatheter aortic valve replacement compared with surgical replacement in patients with severe aortic stenosis and comparable risk: cost-utility and its determinants.

OBJECTIVE To evaluate cost-effectiveness of transfemoral TAVR vs surgical replacement (SAVR) and its determinants in patients with severe symptomatic aortic stenosis and comparable risk. METHODS Patients were prospectively recruited in 6 Spanish hospitals and followed up over one year. We estimated adjusted incremental cost-effectiveness ratio (ICER) (Euros per quality-adjusted life-year [QALY] gained) using a net-benefit approach and assessed the determinants of incremental net-benefit of TAVR vs SAVR. RESULTS We analyzed data on 207 patients: 58, 87 and 62 in the Edwards SAPIEN (ES) TAVR, Medtronic-CoreValve (MC) TAVR and SAVR groups respectively. Average cost per patient of ES-TAVR was €8800 higher than SAVR and the gain in QALY was 0.036. The ICER was €148,525/QALY. The cost of MC-TAVR was €9729 higher than SAVR and the QALY difference was -0.011 (dominated). Results substantially changed in the following conditions: 1) in patients with high preoperative serum creatinine the ICERs were €18,302/QALY and €179,618/QALY for ES and MC-TAVR respectively; 2) a 30% reduction in the cost of TAVR devices decreased the ICER for ES-TAVR to €32,955/QALY; and 3) imputing hospitalization costs from other European countries leads to TAVR being dominant. CONCLUSIONS In countries with relatively low health care costs TAVR is not likely to be cost-effective compared to SAVR in patients with intermediate risk for surgery, mainly because of the high cost of the valve compared to the cost of hospitalization. TAVR could be cost-effective in specific subgroups and in countries with higher hospitalization costs.

TCT-752 Transcatheter Aortic Valve Replacement in Patients with Previous Mitral Surgery - A Multicentre Study.

TCT-752 Transcatheter Aortic Valve Replacement in Patients with Previous Mitral Surgery – A Multicentre Study Ignacio Amat-Santos, Carlos Cortes, Antonio Munoz, Jose Suarez De Lezo, Luis Nombela-Franco, Enrique Gutiérrez, Raul Moreno, Vicente Serra, Jose M. de la Torre Hernandez, Javier Castrodeza, Javier Tobar, Jose A. San Roman Institute of heart science, Valladolid, Spain; Hospital Clinico Universitario De Valladolid, Madrid, Spain; Unknown, Malaga, Spain; Hospital Universitario Reina Sofia, Cordoba, Spain; Quebec City, Quebec, Canada; Hospital Universitario Gregorio Marañón, Madrid; University Hospital La Paz, Madrid, Spain; H. Vall d’Hebron, sant cugat del valles, Spain; Hospital Universitario Marques de Valdecilla, Santander, Spain; Hospital Clínico Universitario de Valladolid, Spain; Hospital Clínico Universitario de Valladolid, Spain; Hospital Clínico Universitario de Valladolid, Spain

PMD25 Cost-Effectiveness of Transcatheter Aortic Valve Implantation (TAVI) in High-Risk or Inoperable Patients with Symptomatic Aortic Valve Stenosis in Spain

Introduction Aortic valve stenosis (AVS) is one of the most frequent structural pathologies of the heart, particularly in older patients [1]. The development of symptoms associated to the disease is an indicator of poor prognosis. It increases the two years mortality risk in more than half of the affected individuals [2]. Open-heart conventional surgery decreases symptoms and improves survival [3]. However, it cannot be performed in about a third of patients due to their poor medical condition [4]. Medical management alone is the only remaining option for this group of patients. Transcatheter Aortic Valve Implantation (TAVI) is a minimally-invasive technique that offers a therapeutic alternative superior to medical management (PARTNER study, US) in inoperable patients with severe AVS. . Over the 3 year period of analysis, 2.12 life years per patient were achieved with TA TAVI, 2.31 with TF TAVI and 1.51 with MEDICAL management, representing 1.24, 1.38 and 0.74 QALYs, respectively (Table 4).