Cost-effectiveness of TAVI in the United Kingdom: a long-term analysis based on 4-year data from the Evolut Low Risk Trial

BackgroundThe cost-effectiveness of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) has previously been reported across the spectrum of surgical mortality risk. We present an updated analysis specific to the UK based on 4-year data from the Evolut Low Risk Trial, which showed a maintained numerical survival benefit with TAVI.MethodsA decision-analytic Markov model was used to project outcomes and costs over a lifetime horizon. Adverse events and utilities were modeled based on 4-year trial data. Beyond 4 years, no difference in long-term survival between TAVR and SAVR was assumed. Costs were informed by NHS England reference costs and reflect resource utilization in the UK TAVI Trial, with costs and effects discounted at 3.5% p.a. The lifetime incremental cost-effectiveness ratio (ICER) was evaluated against the established 20,000- pound pound 30,000 per QALY cost-effectiveness threshold. Extensive sensitivity and scenario analyses were performed, including comparison to prior results based on 12-month data.ResultsTAVI improved survival by 0.41 life years and added 0.28 QALYs at incremental cost of 5,021 pound, resulting in a lifetime ICER of 17,883 pound per QALY gained. 57.5% and 85.3% of probabilistic sensitivity analysis simulations were cost-effective at the 20,000 pound and 30,000 pound per QALY thresholds. Use of 4- vs. 1-year trial data markedly improved lifetime cost-effectiveness.ConclusionRecent 4-year follow-up data from the Evolut Low Risk trial suggest TAVI adds meaningful patient benefit over lifetime and can be expected to be a cost-effective intervention compared to SAVR for low surgical risk patients in a UK setting.