Aortic stenosis (AS) is a common valvular heart disease in elderly people. The causes of AS can be degenerative calcification secondary to atherosclerosis, rheumatic heart disease, congenital bicuspid aortic valve and etc. Severe AS can lead to congestive heart failure and 2-year mortality rate of 50% (Carabello & Paulus, 2009). Patients with AS can be treated with Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR). However, there is no consistent conclusion regarding which one is a better option. Therefore, this study is to compare the differences in cost, effectiveness and cost-effectiveness between TAVI and SAVR using meta-analysis.
Material and methods
This study was conducted using systemic review and meta-analysis. Different combinations of key words were used in searching five databases, including ProQuest Health Research premium Collection, PubMed, OVID LWW online journal, Cochrane Library evidence-based medicine and Elsevier, and Elsevier. After being through PRISMA four stages and flow diagram, 11 articles were selected and further analyzed using CMA III meta-analysis software. Meta-analysis tools used included I2, Q-value, p value, funnel plot, fail-safe number, summary effect size and forest plot.
Results
The differences of cost and effectiveness between TAVI and SAVR were analyzed using meta-analysis whereas incremental cost-effectiveness ratio (ICER) was presented using descriptive statistics. The result showed that the cost of TAVI is higher than that of SAVR. In terms of effectiveness, more patients in TAVI group needed pacemaker implantation and had vascular damage in comparison to SAVR group. There was no difference in other complications, including myocardial infarction, stroke and 30-day mortality. Additionally, patients in TAVI group had a shorter stay in intensive care unit. Furthermore, ICER of TAVI compared with SAVR was considered cost-effective or very cost-effective.
Conclusions
Both TAVI and SAVR were deemed cost-effective. TAVI was more expensive than SAVR; however, the hospital stay after TAVI was shorter than that of SAVR. Nevertheless, none of those studies were carried out in Taiwan hence equivalent studies on Taiwanese population is expected in order to provide our people better options.
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