Transcatheter Aortic Valve Implantation (TAVI) Economics: Current Status

Transcatheter aortic valve implantation (TAVI) is an established treatment for inoperable and high-risk operable symptomatic patients with severe aortic stenosis with growing numbers of procedures and recently expanding indications. However, in reality TAVI remains a very expensive therapy. Cost-effectiveness analyses rely on the value of the incremental cost-effectiveness ratio (ICER) which is the difference in cost between two possible interventions, divided by the difference in their effect. Several analyses have demonstrated that TAVI is cost-effective with an acceptable ICER for the inoperable patient alone and only via the iliofemoral route, while TAVI is more costly and less than or equally effective with surgery in high-risk operable patients. When use of TAVI is extended to include a larger number of patients suitable for surgery, like intermediate- and/or low-risk patients, overall results become economically less favorable for TAVI. Acceptable ICERs should practically equal the value of the gross domestic product (GDP) per capita in each country, however the cost of the TAVI kit alone exceeds the GDP per capita of all moderate- and low-income countries. ICERs in affluent countries presently hover around $ 50,000, costs which are prohibitive for the majority of countries around the world. An overview of the current cost-efficacy issues of TAVI will be presented and this grim reality of the current status of TAVI economics will be discussed, with the hope that this might be appeased in the future.