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Background <p>Aortic valve replacement (AVR) is the standard treatment for severe aortic stenosis. While transcatheter aortic valve implantation (TAVI) has recently been widely recommended, concerns remain regarding real-world long-term valve durability and cost-effectiveness. Rapid deployment valves (RDV) have emerged as an alternative in surgical AVR, offering potential advantages in operative efficiency.</p> Methods <p>This retrospective cohort study compares the clinical outcomes and cost-effectiveness of TAVI versus RDV on patients undergoing AVR between 2012 and 2024 in a single center in Bogota, Colombia. The primary outcomes were all-cause mortality, structural valve deterioration (SVD), and non-structural valve deterioration (NSVD). Multivariable regression models were used to identify predictors of each outcome. The inverse probability of treatment weighting (IPTW) was used to further balance baseline differences. A cost-effectiveness analysis was performed on the IPTW-weighted sample. Probabilistic sensitivity analyses were conducted to assess uncertainty.</p> Results <p>117 patients were included (TAVI: <i>n</i> = 70, RDV: <i>n</i> = 47). TAVI patients were older and had a higher preoperative risk profile than RDV patients. No significant differences were observed in 30-day or follow-up all-cause mortality. In unweighted analyses, SVD occurred more frequently in the TAVI group (aHR: 4.41, 95% CI: 1.22–16.0; <i>p</i> = 0.024), while NSVD was observed exclusively in TAVI patients (<i>p</i> = 0.0017). After IPTW, TAVI was associated with a significantly higher hazard of any form of valve deterioration (aHR: 5.08, 95% CI: 1.41–18.32; <i>p</i> = 0.013). The mean cost of RDV was $42,629, while the cost of TAVI was $73,403. The cost-effectiveness analysis indicated that TAVI was less effective and more expensive and was unlikely to be cost-effective at local willingness-to-pay (WTP) thresholds ($6,947–$20,842). Sensitivity analysis confirmed that RDV was the preferred strategy in 66.6% and 68.5% of simulations under the corresponding WTP thresholds.</p> Conclusions <p>Both RDV and TAVI exhibit comparable safety and mortality profiles. However, TAVI is associated with a higher incidence of valve deterioration and significantly higher costs, making it a less cost-effective option, particularly for the Colombian healthcare system. These findings highlight the importance of individualized procedural selection based on patient characteristics and economic factors. Future research should focus on long-term real-world cost-effectiveness in different socioeconomical contexts and strategies to mitigate valve deterioration in TAVI.</p>

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Cost-effectiveness of rapid-deployment aortic valve replacement over TAVI: a real-world retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月3日

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  • Kevin Maldonado-Cañón,
  • Silvia Alejandra Prada Liévano,
  • Germán Molina,
  • Carlos Pérez Rivera,
  • Héctor Olaya,
  • Valentina Pérez-Ariza,
  • Nicolás Forero,
  • Santiago Niño,
  • Javier Maldonado-Escalante

摘要

Background

Aortic valve replacement (AVR) is the standard treatment for severe aortic stenosis. While transcatheter aortic valve implantation (TAVI) has recently been widely recommended, concerns remain regarding real-world long-term valve durability and cost-effectiveness. Rapid deployment valves (RDV) have emerged as an alternative in surgical AVR, offering potential advantages in operative efficiency.

Methods

This retrospective cohort study compares the clinical outcomes and cost-effectiveness of TAVI versus RDV on patients undergoing AVR between 2012 and 2024 in a single center in Bogota, Colombia. The primary outcomes were all-cause mortality, structural valve deterioration (SVD), and non-structural valve deterioration (NSVD). Multivariable regression models were used to identify predictors of each outcome. The inverse probability of treatment weighting (IPTW) was used to further balance baseline differences. A cost-effectiveness analysis was performed on the IPTW-weighted sample. Probabilistic sensitivity analyses were conducted to assess uncertainty.

Results

117 patients were included (TAVI: n = 70, RDV: n = 47). TAVI patients were older and had a higher preoperative risk profile than RDV patients. No significant differences were observed in 30-day or follow-up all-cause mortality. In unweighted analyses, SVD occurred more frequently in the TAVI group (aHR: 4.41, 95% CI: 1.22–16.0; p = 0.024), while NSVD was observed exclusively in TAVI patients (p = 0.0017). After IPTW, TAVI was associated with a significantly higher hazard of any form of valve deterioration (aHR: 5.08, 95% CI: 1.41–18.32; p = 0.013). The mean cost of RDV was $42,629, while the cost of TAVI was $73,403. The cost-effectiveness analysis indicated that TAVI was less effective and more expensive and was unlikely to be cost-effective at local willingness-to-pay (WTP) thresholds ($6,947–$20,842). Sensitivity analysis confirmed that RDV was the preferred strategy in 66.6% and 68.5% of simulations under the corresponding WTP thresholds.

Conclusions

Both RDV and TAVI exhibit comparable safety and mortality profiles. However, TAVI is associated with a higher incidence of valve deterioration and significantly higher costs, making it a less cost-effective option, particularly for the Colombian healthcare system. These findings highlight the importance of individualized procedural selection based on patient characteristics and economic factors. Future research should focus on long-term real-world cost-effectiveness in different socioeconomical contexts and strategies to mitigate valve deterioration in TAVI.