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The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement


  • Aida Ribera

    (University Hospital Vall d’Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
    University Hospital Vall d’Hebron)

  • John Slof

    (Universitat Autònoma de Barcelona)

  • Ignacio Ferreira-González

    () (University Hospital Vall d’Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
    University Hospital Vall d’Hebron)

  • Vicente Serra

    (University Hospital Vall d’Hebron)

  • Bruno García-del Blanco

    (University of Barcelona)

  • Purificació Cascant

    (University Hospital Vall d’Hebron, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP))

  • Rut Andrea

    (University of Barcelona)

  • Carlos Falces

    (University of Barcelona)

  • Enrique Gutiérrez

    (Universidad Complutense)

  • Raquel del Valle-Fernández

    (Hospital Universitario Central de Asturias)

  • César Morís-de laTassa

    (Hospital Universitario Central de Asturias)

  • Pedro Mota

    (Hospital Clínico Universitario)

  • Juan Francisco Oteo

    (Hospital Puerta de Hierro)

  • Pilar Tornos

    (University Hospital Vall d’Hebron)

  • David García-Dorado

    (University Hospital Vall d’Hebron)


Objectives The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. Methods This is a cost-utility analysis from the perspective of the Spanish National Health Service. Results of two prospective hospital registries (158 and 273 consecutive patients) were incorporated into a probabilistic Markov model to compare quality adjusted life years (QALYs) and costs for TAVR after waiting for 3–12 months, relative to immediate TAVR. We simulated a cohort of 1000 patients, male, and 80 years old; other patient profiles were assessed in sensitivity analyses. Results As waiting time increased, costs decreased at the expense of lower survival and loss of QALYs, leading to incremental cost-effectiveness ratios for eliminating waiting lists of about 12,500 € per QALY. In subgroup analyses prioritization of patients for whom higher benefit was expected led to a smaller loss of QALYs. Concerning budget impact, long waiting lists reduced spending considerably and permanently. Conclusions A shorter waiting time is likely to be cost-effective (considering commonly accepted willingness-to-pay thresholds in Europe) relative to 3 months or longer waiting periods. If waiting lists are nevertheless seen as unavoidable due to severe but temporary budgetary restrictions, prioritizing patients for whom higher benefit is expected appears to be a way of postponing spending without utterly sacrificing patients’ survival and quality of life.

Suggested Citation

  • Aida Ribera & John Slof & Ignacio Ferreira-González & Vicente Serra & Bruno García-del Blanco & Purificació Cascant & Rut Andrea & Carlos Falces & Enrique Gutiérrez & Raquel del Valle-Fernández & Césa, 2018. "The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(7), pages 945-956, September.
  • Handle: RePEc:spr:eujhec:v:19:y:2018:i:7:d:10.1007_s10198-017-0941-3
    DOI: 10.1007/s10198-017-0941-3

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    References listed on IDEAS

    1. Pauline Chauvin & Jean-Michel Josselin & Denis Heresbach, 2014. "The influence of waiting times on cost-effectiveness: a case study of colorectal cancer mass screening," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 801-812, November.
    2. David Morgan & Roberto Astolfi, 2013. "Health Spending Growth at Zero: Which Countries, Which Sectors Are Most Affected?," OECD Health Working Papers 60, OECD Publishing.
    3. Siciliani, Luigi & Stanciole, Anderson & Jacobs, Rowena, 2009. "Do waiting times reduce hospital costs?," Journal of Health Economics, Elsevier, vol. 28(4), pages 771-780, July.
    4. Kahneman, Daniel & Tversky, Amos, 1979. "Prospect Theory: An Analysis of Decision under Risk," Econometrica, Econometric Society, vol. 47(2), pages 263-291, March.
    5. Juan Manuel Ramos-Goni & Oliver Rivero-Arias, 2011. "eq5d: A command to calculate index values for the EQ-5D quality-of-life instrument," Stata Journal, StataCorp LP, vol. 11(1), pages 120-125, March.
    Full references (including those not matched with items on IDEAS)


    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. James Altunkaya’s journal round-up for 3rd September 2018
      by jamesaltunkaya in The Academic Health Economists' Blog on 2018-09-03 11:00:24

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    More about this item


    Waiting lists; Cost-utility; Transcatheter aortic valve replacement; Aortic stenosis;
    All these keywords.

    JEL classification:

    • I - Health, Education, and Welfare
    • I1 - Health, Education, and Welfare - - Health
    • I19 - Health, Education, and Welfare - - Health - - - Other


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