Markov model for selection of aortic valve replacement versus transcatheter aortic valve implantation (without replacement) in high-risk patients

The American Journal of Cardiology
Hemal GadaThomas H Marwick

Abstract

Comparisons between transcatheter aortic valve implantation without replacement (TAVI) and tissue aortic valve replacement (AVR) in clinical trials might not reflect the outcomes in standard clinical practice. This could have important implications for the relative cost-effectiveness of these alternatives for management of severe aortic stenosis in high-risk patients for whom surgery is an option. The mean and variance of risks, transition probabilities, utilities, and cost of TAVI, AVR, and medical management derived from observational studies were entered into a Markov model that examined the progression of patients between relevant health states. The outcomes and cost were derived from 10,000 simulations. Sensitivity analyses were based on variations in the likelihood of mortality, stroke, and other commonly observed outcomes. Both TAVI and AVR were cost-effective compared to medical management. In the reference case (age 80 years, the perioperative TAVI and AVR mortality was 6.9% vs 9.8%, and annual mortality was 21% vs 24%), the utility of TAVI was greater than that of AVR (1.78 vs 1.72 quality-adjusted life years) and the lifetime cost of TAVI exceeded that of AVR ($59,503 vs $56,339). The incremental cost-effectiveness r...Continue Reading

References

Nov 1, 1982·Circulation·F SchwarzW Kübler
Apr 3, 2001·Stroke; a Journal of Cerebral Circulation·T O TengsE Luistro
Oct 8, 2005·American Heart Journal·John SpertusUNKNOWN Cardiovascular Outcomes Research Consortium
Jul 21, 2006·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Patrick W Sullivan, Vahram Ghushchyan
Oct 27, 2006·Cerebrovascular Diseases·Won Chan LeeChris L Pashos
Feb 27, 2007·The Journal of Thoracic and Cardiovascular Surgery·YingXing WuAlbert Starr
Mar 14, 2007·The American Journal of Cardiology·Frederic S ResnicMatthew R Reynolds
Dec 25, 2007·The Annals of Thoracic Surgery·Eugene A GrossiAubrey C Galloway
Apr 4, 2009·Clinical Trials : Journal of the Society for Clinical Trials·Herbert I WeisbergVictor P Pontes
Apr 22, 2009·The Annals of Thoracic Surgery·Sergey LeontyevFriedrich W Mohr
Oct 22, 2010·The New England Journal of Medicine·Martin B LeonUNKNOWN PARTNER Trial Investigators
Nov 16, 2010·European Heart Journal·Thierry LefèvreUNKNOWN PARTNER EU Investigator Group
Jun 7, 2011·The New England Journal of Medicine·Craig R SmithUNKNOWN PARTNER Trial Investigators
Oct 5, 2011·Circulation·Matthew R ReynoldsUNKNOWN Placement of Aortic Transcatheter Valves (PARTNER) Investigators
Nov 15, 2011·Journal of the American College of Cardiology·Peter WenaweserStephan Windecker

❮ Previous
Next ❯

Citations

Aug 23, 2012·Age and Ageing·Panagiota GeorgiadouVassilis Voudris
Sep 18, 2013·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Ruben L J OsnabruggeDavid J Cohen
Nov 28, 2013·The Journal of Thoracic and Cardiovascular Surgery·Praveen IndraratnaChristopher Cao
Mar 15, 2014·Cardiovascular Journal of Africa·Thomas A Mabin, Pascal Condolfi
Sep 28, 2015·The Annals of Thoracic Surgery·Gorav AilawadiJeffrey B Rich
Jul 8, 2014·The Canadian Journal of Cardiology·Gautam Gadey, Matthew R Reynolds
Dec 10, 2014·Applied Health Economics and Health Policy·Andrea Iannaccone, Thomas H Marwick
Feb 1, 2017·Health Economics·Rosanna TarriconeValentina Prevolnik Rupel
Jan 13, 2018·European Heart Journal. Quality of Care & Clinical Outcomes·Fotini GialamaNikolaos Maniadakis
Jul 11, 2013·Circulation. Cardiovascular Quality and Outcomes·Matthew R Reynolds, David J Cohen
Jun 12, 2013·Expert Review of Cardiovascular Therapy·Catherine Y WongMathew Williams
Mar 8, 2017·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·Simone A HuygensMaureen P M H Rutten-van Mölken
Feb 2, 2013·Journal of Medical Economics·Michael J Reardon, Matthew R Reynolds
Sep 5, 2018·The Annals of Thoracic Surgery·Alexander A BresciaDonald S Likosky
Apr 15, 2016·Circulation. Cardiovascular Interventions·Mohammad Abdelghani, Patrick W Serruys

❮ Previous
Next ❯

Related Concepts

Related Feeds

Cardiovascular Diseases: Risk Factors

Cardiovascular disease is a significant health concern. Risk factors include hypertension, obesity, dyslipidemia and smoking. Women who are postmenopausal are at an increased risk of heart disease. Here is the latest research for risk factors of cardiovascular disease.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.