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Systematic review of model-based economic evaluations of heart valve implantations

Author

Listed:
  • Simone A. Huygens

    (Erasmus University Medical Center
    Erasmus University Rotterdam)

  • Johanna. J. M. Takkenberg

    (Erasmus University Medical Center)

  • Maureen P. M. H. Rutten-van Mölken

    (Erasmus University Rotterdam)

Abstract

Objective To review the evidence on the cost-effectiveness of heart valve implantations generated by decision analytic models and to assess their methodological quality. Methods A systematic review was performed including model-based cost-effectiveness analyses of heart valve implantations. Study and model characteristics and cost-effectiveness results were extracted and the methodological quality was assessed using the Philips checklist. Results Fourteen decision-analytic models regarding the cost-effectiveness of heart valve implantations were identified. In most studies transcatheter aortic valve implantation (TAVI) was cost-effective compared to standard treatment (ST) in inoperable or high-risk operable patients (ICER range 18,421–120,779 €) and in all studies surgical aortic valve replacement (SAVR) was cost-effective compared to ST in operable patients (ICER range 14,108–40,944 €), but the results were not consistent on the cost-effectiveness of TAVI versus SAVR in high-risk operable patients (ICER range: dominant to dominated by SAVR). Mechanical mitral valve replacement (MVR) had the lowest costs per success compared to mitral valve repair and biological MVR. The methodological quality of the studies was moderate to good. Conclusion This review showed that improvements can be made in the description and justification of methods and data sources, sensitivity analysis on extrapolation of results, subgroup analyses, consideration of methodological and structural uncertainty, and consistency (i.e. validity) of the models. There are several opportunities for future decision-analytic models of the cost-effectiveness of heart valve implantations: considering heart valve implantations in other valve positions besides the aortic valve, using a societal perspective, and developing patient-simulation models to investigate the impact of patient characteristics on outcomes.

Suggested Citation

  • Simone A. Huygens & Johanna. J. M. Takkenberg & Maureen P. M. H. Rutten-van Mölken, 2018. "Systematic review of model-based economic evaluations of heart valve implantations," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(2), pages 241-255, March.
    • Handle: RePEc:spr:eujhec:v:19:y:2018:i:2:d:10.1007_s10198-017-0880-z
    DOI: 10.1007/s10198-017-0880-z
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    References listed on IDEAS

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    1. Andrea Iannaccone & Thomas Marwick, 2015. "Cost Effectiveness of Transcatheter Aortic Valve Replacement Compared with Medical Management or Surgery for Patients with Aortic Stenosis," Applied Health Economics and Health Policy, Springer, vol. 13(1), pages 29-45, February.
    2. Pieter van Baal & David Meltzer & Werner Brouwer, 2016. "Future Costs, Fixed Healthcare Budgets, and the Decision Rules of Cost‐Effectiveness Analysis," Health Economics, John Wiley & Sons, Ltd., vol. 25(2), pages 237-248, February.
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    More about this item

    Keywords

    Systematic review; Decision-analytic model; Economic evaluation; Heart valve implantations;
    All these keywords.

    JEL classification:

    • I19 - Health, Education, and Welfare - - Health - - - Other

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