Health technology assessment of Transcatether aortic valve implantation (TAVI) as treatment of patients with severe aortic stenosis and intermediate surgical risk – Part 2. Health economic evaluation

Abstract

Key message The National System for Managed Introduction of New Health Technologies within the Specialist Health Service in Norway (Nye Metoder) commissioned the Norwegian Institute of Public Health (NIPH) to perform a health technology assessment evaluating Transcatheter aortic valve implantation (TAVI) as treatment for patients with severe aortic stenosis and intermediate surgical risk. The effect and safety aspects of the intervention are addressed by the rapid assessment published by EUnetHTA in December 2018 (Part 1), co-authored by NIPH. The aim of this report on health economic evaluation was to assess the cost-effectiveness of TAVI for patients with severe aortic stenosis and intermediate surgical risk compared with open surgery against the priority criteria applicable in Norway. The key results are: • The cost-utility analysis indicated that TAVI was slightly more effective (in terms of 0.07 quality-adjusted life-years (QALY) gain) and more costly (in terms of incremental costs of 71 000 Norwegian kroner) than the open surgery. These results were robust to variations in assumption about the time perspective. • The incremental cost-effectivness ratio (ICER) was about 1.04 million Norwegian kroner per QALY in analysis with two-years perspective, falling to about 800 000 kroner per QALY in life time perspective. • The results of sensitivity analysis of our model analysis showed that cost parameters related to the TAVI procedure had the greatest impact on the results (ICER). • We have performed an analysis quantifying the severity criterion by calculating absolute shortfall for patients with severe aortic stenosis and intermediate surgical risk. The results show the absolute shortfall of 3.6 QALYs. • The budget impact analysis based on the results of our cost-effectiveness analysis, and some conservative assumptions about expansion in the use of TAVI indicates that the incremental annual total cost of this expansion will reach 32.5 million Norwegian kroner in the course of five years.