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Is Transcatheter Aortic Valve Implantation as Cost-Effective as Surgical Aortic Valve Replacement?

      Transcatheter aortic valve implantation (TAVI) has emerged as an efficacious and cost-effective treatment for inoperable patients with severe aortic stenosis.
      • Leon M.B.
      • Smith C.R.
      • Mack M.
      • Miller C.
      • Moses J.W.
      • Svensson L.G.
      • Tuzcu M.
      • Webb J.G.
      • Fontana G.P.
      • Makkar R.R.
      • Brown D.L.
      • Block P.C.
      • Guyton R.A.
      • Pichard A.D.
      • Bavaria J.E.
      • Herrmann H.C.
      • Douglas P.S.
      • Petersen J.L.
      • Akin J.J.
      • Anderson W.N.
      • Wang D.
      • Pocock S.
      Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
      For high-risk patients, existing evidence suggests that TAVI has similar periprocedural mortality and stroke outcomes compared with surgical aortic valve replacement (AVR), with higher incidences of paravalvular leak, permanent pacemaker requirement, and vascular injuries after TAVI and higher incidences of major bleeding after AVR.
      • Cao C.
      • Ang S.C.
      • Indraratna P.
      • Manganas C.
      • Bannon P.
      • Black D.
      • Tian D.
      • Yan T.D.
      Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis.
      Regarding the cost-effectiveness of TAVI, a recent systematic review examining its incremental cost-effectiveness ratio in relation to AVR found a paucity of data to demonstrate economic competitiveness of the transcatheter approach.
      • Indraratna P.
      • Ang S.C.
      • Gada H.
      • Yan T.D.
      • Manganas C.
      • Bannon P.
      • Cao C.
      Systematic review of the cost-effectiveness of transcatheter aortic valve implantation.
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      Linked Article

      • Costs and In-Hospital Outcomes of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Commercial Cases Using a Propensity Score Matched Model
        American Journal of CardiologyVol. 115Issue 10
        • Preview
          The aim of this study was to compare in-hospital cost and outcomes between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). TAVI is an effective treatment option in patients with symptomatic aortic stenosis who are at high risk for traditional SAVR. Several studies using trial data or outside United States registry data have addressed TAVI cost issues, although there is a paucity of cost data involving commercial cases in the United States. Using Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Nationwide Inpatient Sample files, a propensity score–matched analysis of all commercial TAVI and SAVR cases performed in 2011 was conducted.
        • Full-Text
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      • Reply
        American Journal of CardiologyVol. 116Issue 6
        • Preview
          We recognize Dr. Cao's comments regarding the study design, analysis, and interpretation of the data presented in our manuscript, and we will address his concerns, many of which are related to the inherent nature of the Nationwide Inpatient Sample (NIS) files, in a direct, stepwise fashion.
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