MedStar Authors catalog › Details for: Cost-Effectiveness of Transcatheter vs. Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis at Intermediate Risk:Results from the PARTNER 2 Trial.
Citation: Circulation. 2018 Nov 29.Journal: Circulation.Published: ; 2018ISSN: 0009-7322.Full author list: Baron SJ; Wang K; House JA; Magnuson EA; Reynolds MR; Makkar R; Herrmann HC; Kodali S; Thourani VH; Kapadia S; Svensson L; Mack MJ; Brown DL; Russo MJ; Smith CR; Webb J; Miller C; Leon MB; Cohen DJ; PARTNER 2 Investigators.UI/PMID: 30586747.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1161/CIRCULATIONAHA.118.035236 (Click here)Abbreviated citation: Circulation. 2018 Nov 29.Local Holdings: Available online from MWHC library: 1950 - present, Available in print through MWHC library: 1999 - 2006.Abstract: BACKGROUND: In patients with severe aortic stenosis (AS) at intermediate surgical risk, treatment with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) results in similar rates of death or stroke at 2 years. Whether TAVR is cost- effective compared with SAVR for intermediate-risk patients remains uncertain.Abstract: METHODS: Between 2011 and 2014, 3110 intermediate-risk AS patients were treated with TAVR or SAVR in the PARTNER-2 Trial. 2032 patients were randomized to receive TAVR using the SAPIEN-XT valve (XT-TAVR) or SAVR in the PARTNER-2A Trial, while the PARTNER-S3i Registry included an additional 1078 patients treated with TAVR using the SAPIEN-3 valve (S3-TAVR), which offers a lower delivery profile and sealing skirt designed to reduce paravalvular regurgitation compared with XT-TAVR. Procedural costs were estimated using measured resource utilization. Other in-trial costs were assessed by linkage of trial data with Medicare claims (n=2333) or by linear regression models for unlinked patients (n=682). Health utilities were estimated using the EQ-5D at baseline, 1, 12, and 24 months. Using a Markov model informed by in-trial costs, utilities, and survival data, lifetime cost-effectiveness from the perspective of the U.S. healthcare system was estimated in terms of cost per quality-adjusted life-year gained.Abstract: RESULTS: Although procedural costs were ~Abstract: CONCLUSIONS: Among intermediate-risk AS patients, TAVR is projected to be economically dominant by providing both greater quality-adjusted life expectancy and lower long-term costs compared with SAVR. If long-term data demonstrate comparable late mortality with TAVR and SAVR, these findings suggest that TAVR may be the preferred treatment strategy for intermediate-risk AS patients based on both clinical and economic considerations.Abstract: CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov Unique Identifier: NCT 01314313.