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Publications

Journal Article Epublish

PubMed: 42502329 DOI: 10.1016/j.jscai.2026.105400

Cost-Effectiveness of Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo-Surgical Aortic Valve Replacement for Degenerated Bioprosthetic Aortic Valve.

J Soc Cardiovasc Angiogr Interv 5(7):105400

Authors: Elina E Pliakos, Andrew M Acker, Paul N Fiorilli, Allison L Tsao, Kendall M Lawrence, Nimesh D Desai, Toby Rogers, Jaffar M Khan, Jay S Giri, Ashwin S Nathan

Affiliations

  • Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
  • Division of Cardiovascular Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
  • MedStar Washington Hospital Center and Georgetown University, Washington, DC.
  • National Heart Lung and Blood Institute, Division of Intramural Research, National Institutes of Health, Bethesda, Maryland.
  • St. Francis Hospital and Heart Center, Roslyn, New York.
  • Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

BACKGROUND

Degenerated bioprosthetic aortic valves are associated with substantial morbidity, mortality, and health care resource use. Treatment options include redo-surgical aortic valve replacement (redo-SAVR) and valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). ViV-TAVR has been associated with shorter length of stay, but its higher device costs have raised uncertainty about its overall economic value. We constructed a decision-analytic model to compare the cost-effectiveness of ViV-TAVR vs redo-SAVR for the management of degenerated bioprosthetic aortic valves.

METHODS

Cost-effectiveness was evaluated by calculating deaths averted and incremental cost-effectiveness ratios (ICERs). The main outcome was ICER defined as US dollars/deaths averted. Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds.

RESULTS

In the probabilistic analysis, the mean total cost of ViV-TAVR was 88,829 (95% CI, 88,554-89,104) with a 2-month survival probability of 0.97 (95% CI, 0.969-0.970). For redo-SAVR, the mean cost was 91,411 (95% CI, 91,163-91,659) with a 2-month survival probability of 0.96 (95% CI, 0.959-0.961). ViV-TAVR was the dominant strategy, resulting in a mean ICER of -259,323 per death averted (95% CI, -304,599 to -220,679). ViV-TAVR was cost effective in 57% to 58% of simulations for willingness-to-pay thresholds ranging from 0 to 150,000.

CONCLUSIONS

ViV-TAVR is an economically dominant strategy for the management of degenerated bioprosthetic aortic valves, yielding lower costs and marginally improved short-term survival relative to redo-SAVR. However, given a moderate degree of decisional uncertainty, trial-level comparative data and longer-term modeling are required to refine these estimates.

MeSH

Probability, Uncertainty, Aortic Valve, Transcatheter Aortic Valve Replacement, Surgical Aortic Valve Replacement