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An analysis of real-world cost-effectiveness of TAVI in South Africa.

Mabin TA, Condolfi P - Cardiovasc J Afr (2014 Jan-Feb)

Bottom Line: The subset of cAVR patients were derived from the relevant and available information in the database and their costs were compared with TAVI costs.Within the context of limited clinical data we performed the first attempt at cost-effective analysis of TAVI vs cAVR in South Africa.Despite common perceptions on costs, adoption of TAVI as an alternative, less-invasive therapy that has been clinically proven and recommended by an FDA advisory panel (Partner A) to be at least as effective as cAVR, has a viable economic argument in appropriate patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: MediClinic Vergelegen, Somerset West, South Africa.

ABSTRACT

Objective: Transcatheter aortic valve implantation (TAVI) has become the standard of care for inoperable patients with severe aortic stenosis and is an alternative to conventional surgery for high-risk aortic valve replacement (AVR) patients. There is a positive correlation between severity of pre-operative patients and hospital costs. The aim of this study was to compare empirically derived costs of the two therapies in South Africa.

Methods: The cost-comparison analysis was performed with a MediClinic database including 239 conventional isolated AVR (cAVR) and 75 TAVI cases. All costs are given in 2011 ZAR. The subset of cAVR patients were derived from the relevant and available information in the database and their costs were compared with TAVI costs.

Results: From the 75 available subjects, mean TAVI costs were ZAR 335.5k ± 47.9k, (median ZAR 326.5k) with a mean (median) ICU and hospital length of stay (LoS) of 2.7 (2.0) and 7.6 (6.5) days, respectively. The mean cAVR cost was lower at ZAR 213.9 ± 87.5k (median ZAR 193.6k) but this included the entire population costs (i.e. low to high surgical risk). When estimating cAVR costs, defined by LoS of more than six and 13 days in the ICU and hospital, respectively, and being over 75 years of age, the estimate increased to ZAR 337.9k, which was above the TAVI mean costs. In-hospital mortality was 5.3 and 7.9% for TAVI and the entire cAVR group, respectively. When considering the subset of cAVR patients most likely to be high risk, it increased to 21.4%.

Conclusion: Within the context of limited clinical data we performed the first attempt at cost-effective analysis of TAVI vs cAVR in South Africa. Treatment of aortic stenosis with cAVR in a post hoc defined high-risk patient segment was more expensive than TAVI in South African centres. Despite common perceptions on costs, adoption of TAVI as an alternative, less-invasive therapy that has been clinically proven and recommended by an FDA advisory panel (Partner A) to be at least as effective as cAVR, has a viable economic argument in appropriate patients.

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Related in: MedlinePlus

Correlation of age with total costs of cAVR.
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Figure 5: Correlation of age with total costs of cAVR.

Mentions: By contrast, age and gender, our only two pre-operative variables available, were not predictors of cost. The linear correlation between age and total costs was statistically significant (p < 0.001) but the coefficient, also positive, was low in comparison with the previous one of 0.226 (Fig. 5). The total cost distributions were similar for both sexes (Fig. 6).


An analysis of real-world cost-effectiveness of TAVI in South Africa.

Mabin TA, Condolfi P - Cardiovasc J Afr (2014 Jan-Feb)

Correlation of age with total costs of cAVR.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959180&req=5

Figure 5: Correlation of age with total costs of cAVR.
Mentions: By contrast, age and gender, our only two pre-operative variables available, were not predictors of cost. The linear correlation between age and total costs was statistically significant (p < 0.001) but the coefficient, also positive, was low in comparison with the previous one of 0.226 (Fig. 5). The total cost distributions were similar for both sexes (Fig. 6).

Bottom Line: The subset of cAVR patients were derived from the relevant and available information in the database and their costs were compared with TAVI costs.Within the context of limited clinical data we performed the first attempt at cost-effective analysis of TAVI vs cAVR in South Africa.Despite common perceptions on costs, adoption of TAVI as an alternative, less-invasive therapy that has been clinically proven and recommended by an FDA advisory panel (Partner A) to be at least as effective as cAVR, has a viable economic argument in appropriate patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: MediClinic Vergelegen, Somerset West, South Africa.

ABSTRACT

Objective: Transcatheter aortic valve implantation (TAVI) has become the standard of care for inoperable patients with severe aortic stenosis and is an alternative to conventional surgery for high-risk aortic valve replacement (AVR) patients. There is a positive correlation between severity of pre-operative patients and hospital costs. The aim of this study was to compare empirically derived costs of the two therapies in South Africa.

Methods: The cost-comparison analysis was performed with a MediClinic database including 239 conventional isolated AVR (cAVR) and 75 TAVI cases. All costs are given in 2011 ZAR. The subset of cAVR patients were derived from the relevant and available information in the database and their costs were compared with TAVI costs.

Results: From the 75 available subjects, mean TAVI costs were ZAR 335.5k ± 47.9k, (median ZAR 326.5k) with a mean (median) ICU and hospital length of stay (LoS) of 2.7 (2.0) and 7.6 (6.5) days, respectively. The mean cAVR cost was lower at ZAR 213.9 ± 87.5k (median ZAR 193.6k) but this included the entire population costs (i.e. low to high surgical risk). When estimating cAVR costs, defined by LoS of more than six and 13 days in the ICU and hospital, respectively, and being over 75 years of age, the estimate increased to ZAR 337.9k, which was above the TAVI mean costs. In-hospital mortality was 5.3 and 7.9% for TAVI and the entire cAVR group, respectively. When considering the subset of cAVR patients most likely to be high risk, it increased to 21.4%.

Conclusion: Within the context of limited clinical data we performed the first attempt at cost-effective analysis of TAVI vs cAVR in South Africa. Treatment of aortic stenosis with cAVR in a post hoc defined high-risk patient segment was more expensive than TAVI in South African centres. Despite common perceptions on costs, adoption of TAVI as an alternative, less-invasive therapy that has been clinically proven and recommended by an FDA advisory panel (Partner A) to be at least as effective as cAVR, has a viable economic argument in appropriate patients.

Show MeSH
Related in: MedlinePlus