An exploratory cost-effectiveness analysis of a novel tissue valve compared with mechanical valves for surgical aortic valve replacement in subgroups of people aged 55–64 and 65+ with aortic stenosis in the UK

ABSTRACT

Objective

Exploratory analysis to conceptualize and evaluate the potential cost-effectiveness and economic drivers of using a novel tissue valve compared with mechanical heart valves for surgical aortic valve replacement (SAVR) in people aged 55–64 and 65+ with aortic stenosis (AS) from a National Health Service (NHS) UK perspective.

Methods

A decision-analytic model was developed using a partitioned survival model. Parameter inputs were obtained from published literature. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted to explore the uncertainty around the parameters.

Results

The novel tissue valve was potentially associated with higher quality-adjusted life years (QALYs) of 0.01 per person. Potential cost savings were greatest for those aged 55–64 (£408) versus those aged 65+(£53). DSA indicated the results to be most dependent on relative differences in general mortality, procedure costs, and reoperation rates. PSA estimated around 75% of the iterations to be cost-effective at £20,000 per QALY for those aged 55–64, and 57% for those aged 65+.

Conclusions

The exploratory analysis suggests that the novel tissue valve could be a cost-effective intervention for people over the age of 55 with AS who are suitable for SAVR in the UK.

KEYWORDS:

• Surgical aortic valve replacement
• bioprosthetic valve
• aortic stenosis
• health economics
• cost-effectiveness
• NHS

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

R Malcolm, C Buckley, and J Shore were involved in the conceptualization and design of the economic model, with input from A White, B Marti. N Nikolaidis, A Lopez, and O Wendler provided critical input from a clinical perspective for the model design. The analyses were undertaken and guided by R Malcolm, J Shore, C Buckley, A Stainthorpe, and J Carapinha. Review was provided by M Vernia, J Deckert, A White, B Marti, and J Carapinha. The manuscript was initially drafted by R Malcolm, C Buckley, J Shore, and A Stainthorpe. Critical revision was provided by all other authors. All authors read and approved the final version of the manuscript for publication.

Acknowledgments

Michelle Green gave advice in the design of the economic model to evaluate using the bioprosthetic valve with a novel tissue in the UK.

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2249611

Additional information

Funding

R Malcolm, J Shore, C Buckley, and A Stainthorpe are employed by the York Health Economics Consortium (YHEC). YHEC was funded by Edwards Lifesciences to develop the economic model and manuscript.