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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EFor patients with inoperable severe aortic stenosis, the incremental cost per life-year gained for transcatheter aortic valve replacement is in line with values for other cardiovascular technologies. This article presents these findings, which are based on a cost-effectiveness study of the PARTNER trial (Cohort B).\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EFor patients with inoperable severe aortic stenosis, the incremental cost per life-year gained (LYG) for transcatheter aortic valve replacement (TAVR) is in line with values for other cardiovascular (CV) technologies. Matthew R. Reynolds, MD, MSc, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA, presented these findings, which are based on a cost-effectiveness study of the PARTNER trial (Cohort B).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EData for Cohort B of the PARTNER trial showed that TAVR offers substantial clinical outcome benefits, compared with standard care, for patients who are unsuitable for surgical aortic valve replacement (AVR) [Leon MB et al. \u003Cem\u003ENEJM\u003C\/em\u003E 2010]. The economic analysis was designed to compare the two treatment approaches with respect to short-term and long-term costs and lifetime cost-effectiveness.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThis study included all 358 subjects in Cohort B. The primary endpoint was the lifetime incremental cost-effectiveness ratio (ICER), expressed as cost per LYG. The secondary endpoint was lifetime incremental cost per quality-adjusted life-year gained (QALY).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe mean initial cost of TAVR was $78,540, which represented the procedural costs, nonprocedural costs, and estimated physician fees. Within the 12-month period of the PARTNER trial, the total follow-up cost (excluding the initial cost) was significantly lower for TAVR ($29,352) than for standard therapy ($52,724)\u2014a difference of $23,372 (p\u0026lt;0.001). The greater follow-up cost that was associated with standard therapy was related to a significantly higher hospitalization rate (2.15 vs 1.02; p\u0026lt;0.001). This higher rate was due entirely to admissions for CV causes. The greater hospitalization cost that was associated with standard therapy was offset slightly by higher costs for rehabilitation and skilled nursing facilities that are associated with TAVR (total 12-month cost difference, $23,372; p\u0026lt;0.001).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EUsing parametric survival models to extrapolate life expectancy beyond the observed follow-up period, the researchers estimated a 1.9-year-longer life expectancy for TAVR compared with standard care (3.1 vs 1.2 years). The lifetime incremental cost of TAVR was $79,837, with a lifetime incremental gain in life expectancy of 1.59 years (TAVR-control) after applying a standard economic discount rate of 3% per year to both future costs and benefits. The resultant incremental cost-effectiveness ratio was $50,212\/LGY. Bootstrap resampling demonstrated that the probability of cost-effectiveness was 47% for a threshold of $50,000 per LYG and 95% for a threshold of $60,000\/LYG.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EWhen the effectiveness measure was changed from LYG to QALYs gained for the secondary analysis, the incremental benefit decreased slightly (1.29 QALYs).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe authors note that these results compare favorably with the costs of other currently used CV treatments, including implantable cardiac defibrillators and atrial fibrillation ablation, and cost less than hemodialysis, percutaneous coronary intervention for stable disease, and left ventricular assist devices.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe study has several limitations. Because the experience with TAVR is still early, care may become more efficient in the future. In addition, care of the control group in the trial may have differed from that for similar patients in community practice. There is also some uncertainty about the lifetime analysis in the study\u2014particularly the cost projections beyond the trial period. Lastly, the patient population of Cohort B was old and at high risk, and the results can not be extrapolated to other patient groups.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EStill to be determined is the cost-effectiveness of TAVR compared with surgical AVR, an important point, given the most recent PARTNER data that showed similar clinical outcomes for these two procedures.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/3\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn361\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}