07 Nov 2021
PARTNER 3: weighing the comparative costs and savings of TAVI versus SAVR in low-risk patients with severe aortic stenosis
Reported from TCT 2021
Professor David J. Cohen presented the results of the economic outcomes of the PARTNER 3 trial on Friday, 5 November, in the Late-Breaking Trial session of the Transcatheter Cardiovascular Therapeutics Congress 2021. Giuseppe Biondi-Zoccai provides his analysis of this study.
Rationale
The rationale behind the economic analysis of the PARTNER 3 trial was to appraise the comparative costs and potential savings associated with TAVI (transcatheter aortic valve implantation), or replacement [TAVR vs SAVR (surgical aortic valve replacement)] in a population of patients with severe aortic stenosis at low surgical risk.
Here are the basic facts of the PARTNER 3 trial, whose primary analysis has been reported previously (https://www.jacc.org/doi/10.1016/j.jacc.2020.12.052).
- Population: all 929 patients enrolled in the US (from a total sample of 1000 subjects) were included.
- Intervention: TAVI with Sapien3 vs SAVR with a surgical bioprosthetic valve
- Outcomes: costs (based on linked Medicare claims, life-years, and quality-adjusted life-years (QALYs)
- Time: up to 2 years of follow-up (with long-term projections)
Interpretation
The newly reported economic analysis of the PARTNER 3 trial provides important insights on the comparative effectiveness of TAVI in low-risk surgical patients (average age: 74 years old, STS score 1.9 %), capitalizing on accurate data collection and analysis.
In particular, the main finding was that overall costs at 2 years were clearly favoring TAVI, including costs adjusted per QALY. This held true despite much higher device costs for TAVI ($ 37,370 vs $ 18,327 for SAVR). Savings associated with TAVI depended heavily on the shorter hospital stays (in general and in intensive care unit).
The economic appeal of TAVI in comparison to SAVR was confirmed in various scenarios at 2 years and beyond, and could be projected as even greater in patients with greater symptomatic burden.
Furthermore, cost divide in favor of TAVR could be even greater if TAVI device prices decrease substantially (or if a cheaper device is chosen).
Similarly, reducing length of stay after TAVI (e.g. early discharge without any intensive care unit stay) could increase the economic appeal of TAVI even more.
The only scenario in which TAVI could become economically inferior to SAVR would be in case of greater mortality and morbidity with TAVI at longer-term follow-up (e.g. 5 or even 10 years), but, to date, there is no signal from this and other trials of such earlier deterioration of valve performance of TAVI.
In conclusion, despite the focus on US healthcare system and costs (which may be extrapolated to non-US scenarios with caution), TAVI is clearly cost-effective in comparison to SAVR in low-risk patients with severe aortic stenosis at 2 years, and probably even at longer-term follow-up.
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