Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk

Figures & data

Figure 1 DES model for the in-hospital phase (top-left box) and lifetime Markov model (bottom-right box) for SU-AVR vs TAVIs comparison.

Abbreviations: DES, discrete event simulation; ICU, intensive care unit; PMI, pacemaker implantation; PVL, paravalvular leak; RBC, red blood cell; RD, renal dysfunction; SU-AVR, sutureless aortic valve replacement; TAVIs, transcatheter aortic valve implants.

Figure 2 Kaplan–Meier overall survival with and without PVL compared with fitted curves obtained from Weibull regression (dashed lines).

Note: From The New England Journal of Medicine, Susheel K Kodali, Mathew R Williams, Craig R Smith, et al, Two-year outcomes after transcatheter or surgical aortic-valve replacement, vol 366, pages 1686–1695. Copyright © (2018) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.²⁴
Abbreviation: PVL, paravalvular leak.

Figure 3 Hospitalization-free survival after hospital discharge for SU-AVR and TAVI patients.

Abbreviations: SU-AVR, sutureless aortic valve replacement; TAVI, transcatheter aortic valve implant.

Figure 4 NYHA distribution after discharge and time evolution up to 4 years.

Abbreviations: NYHA, New York Heart Association; SU-AVR, sutureless aortic valve replacement; TAVI, transcatheter aortic valve implant.

Table 1 List of unit/annual/per episode costs used in the model for each country considered in the analysis

	US $		Germany €		France €		Italy €		UK £		Australia AUD
In-hospital costs
Operating room
TAVI	6,641.92	^Citation7	4,522.77	^Citation13	3,363.70	^Citation37	5,401.22a		5,586.81a		1,204.80	^Citation38
SU-AVR	7,818.74a		5,324.11	^Citation13	7,120.36b		6,358.20b		6,576.68b		6,917.00	^Citation38
Diagnostic
TAVI	4,831.32	^Citation40	4,339.22	^Citation13	4,633.46c		4,927.70d		1,706.91	^Citation41,Citation42	2,731.98	^Citation43
SU-AVR	2,199.03d		1,975.04	^Citation13	2,108.97c		2,242.89	^Citation44	776.92d		1,243.49d
Device
TAVI	32,000.00	^Citation7	11,000.00e						14,500.00e		22,932.00	^Citation45
SU-AVR	12,220.46	^Citation46	6,000.00e						6,000.00e		8,977.00
Reoperationf
TAVI	6,544.97		4,526.83		3,519.83		5,318.93		5,107.67		1,634.47
SU-AVR	7,207.58		5,193.18		7,260.40		6,125.62		5,796.47		7,101.56
ICU (daily cost)	1,303.45	^Citation50	1,196.46	^Citation51	1,578.41	^Citation52	1,469.90	^Citation53	1,360.00	^Citation54	4,877.46	^Citation55
Ward (daily cost)	779.98	^Citation50	469.88	^Citation51	443.15	^Citation51	484.20	^Citation53	280.00	^Citation54	789.80	^Citation56
RBC (cost per unit)	295.94	^Citation50	105.53	^Citation51	108.45	^Citation37	153.00	^Citation51	127.70	^Citation57	231.26	^Citation58
RRT (daily cost)	978.10	^Citation50	76.26	^Citation51	152.74	^Citation51	284.81	^Citation51	159.81	^Citation57	160.46	^Citation59
In-hospital stroke	16,732.36	^Citation50	4,854.25	^Citation49	5,860.67c		6,867.10	^Citation61	3,479.00	^Citation54	11,126.72	^Citation62
In-hospital PMI	5,974.25	^Citation48	4,507.15	^Citation49	3,242.59	^Citation37	3,265.73	^Citation63	2,886.00	^Citation54	4,692.00	^Citation38
Long-term costs
Dialysis (annual cost)	67,497.35	^Citation64	60,732.30	^Citation65	53,047.50	^Citation66	42,815.78	^Citation67	23,713.95	^Citation68	111,618.17	^Citation69
Rehospitalization (cost per episode)
Stroke (cost per episode)	47,896.34	^Citation70	23,385.34	^Citation66	11,457.14	^Citation66	13,967.46	^Citation66	19,063.18	^Citation71	41,008.49	^Citation66
PMI (cost per episode)	48,211.79	^Citation72	8,945.02	^Citation73	11,938.56	^Citation74	12,133,59	^Citation63	10,256.07	^Citation75	14,208.18	^Citation38
Others (cost per episode)	27,249.08	^Citation64	11,921.67	^Citation66	9,905.65	^Citation66	11,399.58	^Citation66	7,168.98	^Citation76,Citation77	18,046.01	^Citation66

Notes:

a Estimated by applying the ratio between TAVIs and Perceval operating room costs reported in Santarpino et al¹³ as it is the only analysis that reported both costs in the same structure.

b Calculated as the mean of full-sternotomy (FS), minimally invasive (MiS), and concomitant (CONC) procedures estimated in Pradelli et al⁹ weighted for the frequencies of FS (41%), MiS (26%), and CONC (33%) reported in Shrestha et al.³⁹

c Estimated as the mean between Germany and Italy.

d Estimated by applying the ratio between TAVIs and Perceval diagnostic costs reported in Santarpino et al¹³ as it is the only analysis that reported both costs in the same structure.

e Market values.

f Calculated as the cost of operating room plus the cost of device for the 2.0% of patients who need a second valve implant.^47–49 The superscript numbers represent reference citations.

Abbreviations: ICU, intensive care unit; PMI, pacemaker implantation; RBC, red blood cell; RRT, renal replacement therapy; SU-AVR, sutureless aortic valve replacement; TAVIs, transcatheter aortic valve implants.

Table 2 Effectiveness results: values expressed as mean and interquartile range

	TAVIs	SU-AVR	Delta (SU-AVR vs TAVIs)
In-hospital outcomes
30-day mortality	7.0% (6.1%; 8.1%)	4.1% (3.2%; 4.8%)	−2.9% (−3.7%; −2.1%)
Renal dysfunction	2.6% (2.0%; 3.1%)	2.6% (2.0%; 3.1%)	0%
Reoperation	4.7% (4.5%; 4.7%)	11.3% (8.4%; 14.9%)	6.7% (3.9%; 10.3%)
Stroke	2.3% (1.8%; 2.8%)	1.2% (0.8%; 1.5%)	−1.1% (−1.4%; −0.8%)
PMI	18.8% (15.7%; 21.1%)	18.8% (15.7%; 21.1%)	0%
PVL	54.4% (51.5%; 58.8%)	8.9% (7.6%; 10.5%)	−45.5% (−49.1%; −42.5%)
POVC (major)	7.7% (5.7%; 10.1%)	0.4% (0.1%; 0.8%)	−7.3% (−9.3%; −5.3%)
RBC units	0.85 (0.82; 0.88)	1.21 (1.17; 1.25)	0.36 (0.31; 0.41)
Hospital stay (days)	7.33 (7.09; 7.58)	10.56 (10.00; 11.17)	3.23 (2.73; 3.77)
Long-term outcomes
LY	4.26 (3.98; 4.52)	5.51 (5.25; 5.75)	1.25 (1.03; 1.44)
QALY	3.44 (3.15; 3.60)	4.58 (4.31; 4.72)	1.14 (0.98; 1.31)
Dialysis	5.6% (4.7%; 6.3%)	8.4% (7.3%; 9.2%)	2.8% (2.2%; 3.2%)
Rehospitalization	44.2% (39.5%; 48.3%)	32.5% (26.8%; 38.6%)	−11.7% (−14.1%; −8.2%)

Note: Interquartile ranges are provided in parentheses.

Abbreviations: LY, life-year; PMI, pacemaker implantation; POVC, postoperative vascular complication; PVL, paravalvular leak; QALY, quality-adjusted life-year; RBC, red blood cell; SU-AVR, sutureless aortic valve replacement; TAVIs, transcatheter aortic valve implants.

Figure 5 Comparison between incremental cost items for the six analyzed countries.

Notes: All values are expressed in 2017 US$ (negative increments favor SU-AVR, while positive increments favor TAVIs). €1= €1.1870, £1=$1.3372, AU$1=$0.7704.
Abbreviations: SU-AVR, sutureless aortic valve replacement; TAVIs, transcatheter aortic valve implants; w/o, without.

Table 3 Economic results: values expressed as mean and interquartile range

	TAVIs	SU-AVR	Delta (SU-AVR vs TAVIs)
Total costs (US $)	69,389 (67,459; 75,965)	48,459 (45,647; 53,536)	−20,930 (−26,084; −17,671)
Hospital costs	52,727 (51,518; 53,806)	34,375 (33,724; 35,089)	−18,351 (−19,556; −16,951)
Operating room	6,642 (6,545; 6,742)	7,819 (7,690; 7,936)	1,177 (1,015; 1,320)
Device cost	32,000 (30,857; 32,985)	12,220 (11,833; 12,616)	−19,780 (−20,863; −18,539)
Diagnostics	4,831 (4,668; 4,990)	2,199 (2,123; 2,270)	−2,632 (−2,800; −2,449)
Hospital staya	6,234 (5,949; 6,504)	8,753 (8,285; 9,241)	2,519 (2,140; 2,958)
Complicationsb	3,020 (2,813; 3,186)	3,384 (3,126; 3,716)	365 (163; 627)
Long-term costs	16,663 (15,102; 22,791)	14,084 (11,297; 18,978)	−2,579 (−8,020; 423)
Dialysis	278 (231; 309)	408 (351; 445)	130 (103; 148)
Rehospitalization	16,385 (14,802; 22,498)	13,676 (10,916; 18,573)	−2,709 (−8,124; 300)
Total costs (Germany €)	31,722 (30,704; 33,580)	24,951 (24,273; 26,668)	−6,772 (−8,203; −5,109)
Hospital costs	25,355 (24,893; 25,807)	20,598 (20,259; 21,128)	−4,757 (−5,307; −4,065)
Operating room	4,523 (4,421; 4,611)	5,324 (5,211; 5,416)	801 (653; 934)
Device cost	11,000 (10,626; 11,364)	6,000 (5,801; 6,231)	−5,000 (−5,445; −4,563)
Diagnostics	4,339 (4,124; 4,589)	1,975 (1,843; 2,107)	−2,364 (−2,634; −2,114)
Hospital staya	4,159 (4,003; 4,326)	5,677 (5,375; 6,010)	1,518 (1,279; 1,787)
Complicationsb	1,334 (1,191; 1,472)	1,622 (1,444; 1,854)	288 (165; 455)
Long-term costs	6,367 (5,500; 7,976)	4,353 (3,566; 5,974)	−2,014 (−3,341; −579)
Dialysis	250 (210; 282)	367 (318; 402)	117 (92; 135)
Rehospitalization	6,117 (5,270; 7,717)	3,986 (3,218; 5,596)	−2,131 (−3,428; −697)
Total costs (UK £)	30,511 (29,886; 32,308)	22,520 (21,751; 23,930)	−7,991 (−9,664; −6,889)
Hospital costs	26,032 (25,437; 26,515)	18,846 (18,473; 19,290)	−7,186 (−7,794; −6,481)
Operating room	5,587 (5,348; 5,794)	6,577 (6,300; 6,849)	990 (641; 1,375)
Device cost	14,500 (13,979; 14,973)	6,000 (5,779; 6,192)	−8,500 (−9,041; −7,976)
Diagnostics	1,707 (1,649; 1,767)	777 (751; 804)	−930 (−997; −867)
Hospital staya	3,113 (3,000; 3,225)	4,018 (3,817; 4,220)	904 (764; 1,064)
Complicationsb	1,125 (1,033; 1,212)	1,475 (1,303; 1,680)	349 (196; 528)
Long-term costs	4,479 (3,939; 6,285)	3,674 (2,981; 4,892)	−805 (−2,295; −4)
Dialysis	98 (82; 109)	143 (124; 155)	46 (36; 51)
Rehospitalization	4,381 (3,839; 6,190)	3,531 (2,831; 4,748)	−850 (−2,337; −45)
Total costs (France €)	29,870 (29,092; 31,339)	26,365 (25,553; 27,638)	−3,504 (−4,949; −2,376)
Hospital costs	24,510 (24,064; 24,941)	22,385 (21,872; 22,884)	−2,125 (−2,765; −1,486)
Operating room	3,364 (3,322; 3,405)	7,120 (6,805; 7,410)	3,757 (3,418; 4,050)
Device cost	11,000 (10,588; 11,373)	6,000 (5,781; 6,200)	−5,000 (−5,418; −4,581)
Diagnostics	4,633 (4,484; 4,789)	2,109 (2,042; 2,181)	−2,524 (−2,690; −2,369)
Hospital staya	4,364 (4,203; 4,507)	5,795 (5,471; 6,095)	1,431 (1,173; 1,676)
Complicationsb	1,149 (1,043; 1,246)	1,360 (1,229; 1,529)	211 (102; 331)
Long-term costs	5,359 (4,738; 6,714)	3,980 (3,261; 5,068)	−1,379 (−2,581; −530)
Dialysis	219 (184; 243)	320 (278; 350)	102 (80; 115)
Rehospitalization	5,141 (4,513; 6,487)	3,660 (2,958; 4,763)	−1,481 (−2,661; −632)
Total costs (Italy €)	33,250 (32,384; 35,038)	26,679 (25,833; 28,206)	−6,570 (−7,989; −5,314)
Hospital costs	27,275 (26,691; 27,884)	22,447 (21,862; 23,232)	−4,827 (−5,439; −3,973)
Operating room	5,401 (5,187; 5,620)	6,358 (6,080; 6,627)	957 (590; 1,294)
Device cost	11,000 (10,623; 11,351)	6,000 (5,797; 6,205)	−5,000 (−5,413; −4,553)
Diagnostics	4,928 (4,756; 5,073)	2,243 (2,172; 2,323)	−2,685 (−2,847; −2,476)
Hospital staya	4,518 (4,212; 4,851)	6,082 (5,615; 6,619)	1,564 (1,298; 1,874)
Complicationsb	1,427 (1,328; 1,531)	1,764 (1,595; 2,014)	336 (176; 539)
Long-term costs	5,975 (5,305; 7,497)	4,232 (3,493; 5,474)	−1,743 (−2,946; −853)
Dialysis	176 (148; 197)	259 (225; 281)	82 (66; 93)
Rehospitalization	5,799 (5,137; 7,323)	3,973 (3,255; 5,226)	−1,825 (−3,018; −944)
Total costs (Australia AUD)	48,285 (47,135; 51,267)	38,269 (36,821; 40,985)	−10,016 (−12,819; −7,568)
Hospital costs	38,238 (37,446; 39,130)	31,132 (30,514; 31,838)	−7,106 (−8,137; −6,156)
Operating room	1,205 (1,167; 1,249)	6,917 (6,682; 7,135)	5,712 (5,451; 5,922)
Device cost	22,932 (22,205; 23,778)	8,977 (8,658; 9,247)	−13,955 (−14,883; −13,168)
Diagnostics	2,732 (2,685; 2,781)	1,243 (1,224; 1,265)	−1,488 (−1,540; −1,437)
Hospital staya	9,804 (9,467; 10,137)	12,355 (11,841; 12,983)	2,551 (2,194; 3,008)
Complicationsb	1,566 (1,412; 1,719)	1,640 (1,484; 1,818)	74 (7; 149)
Long-term costs	10,047 (8,767; 12,854)	7,137 (5,828; 9,607)	−2,910 (−5,546; −684)
Dialysis	460 (384; 510)	674 (587; 729)	214 (170; 239)
Rehospitalization	9,587 (8,294; 12,372)	6,463 (5,176; 8,950)	−3,124 (−5,738; −890)

Notes: Interquartile ranges are provided in parentheses.

a Including intensive care unit stay.

b Reoperation, renal replacement therapy, transfusion of red blood cell units, stroke, pacemaker implantation.

Abbreviations: TAVIs, transcatheter aortic valve implants; SU-AVR, sutureless aortic valve replacement.

Figure 6 Joint distribution of cost and QALY differences for the six countries considered in the analysis (the result of 1,000 samples); continuous line represents the 95% confidence ellipse.

Abbreviations: QALYs, quality-adjusted life-years; SU-AVA, sutureless aortic valve replacement TAVI, transcatheter aortic valve implant.

Figure 7 Tornado diagram of QALY gain (SU-AVR vs TAVIs): Blue bars (min) represent QALY gain for the minimum value of each parameter, and orange bars (max) represent QALY gain for the maximum value of each parameter.

Abbreviations: NYHA, New York Heart Association; OS, overall survival; PVL, paravalvular leak; QALY, quality-adjusted life-year; RR, relative risk; SU-AVR, sutureless aortic valve replacement; TAVIs, transcatheter aortic valve implants.

Figure 8 Tornado diagram of cost differences (SU-AVR vs TAVIs) for the six countries considered in the analysis: Blue bars (min) represent cost differences for the minimum value of each parameter and orange bars (max) represent delta cost for the maximum value of each parameter.

Abbreviations: OR, operating room; OS, overall survival; PVL, paravalvular leak; PMI, pacemaker implantation; RR, relative risk; SU-AVR, sutureless aortic valve replacement; TAVIs, transcatheter aortic valve implants.

KodaliSKWilliamsMRSmithCRTwo-year outcomes after transcatheter or surgical aortic-valve replacementN Engl J Med Overseas Ed20123661816861695

 PubMed Web of Science ®Google Scholar

ReynoldsMRLeiYWangKCost-Effectiveness of Transcatheter Aortic Valve Replacement With a Self-Expanding Prosthesis Versus Surgical Aortic Valve ReplacementJ Am Coll Cardiol2016671293826764063

 PubMed Web of Science ®Google Scholar

SantarpinoGPfeifferSJesslJClinical Outcome and Cost Analysis of Sutureless Versus Transcatheter Aortic Valve Implantation With Propensity Score Matching AnalysisAm J Cardiol2015116111737174326433277

 PubMed Web of Science ®Google Scholar

ChevreulKBrunnMCadierBCost of transcatheter aortic valve implantation and factors associated with higher hospital stay cost in patients of the FRANCE (FRench Aortic National CoreValve and Edwards) registryArch Cardiovasc Dis2013106420921923706367

 PubMed Web of Science ®Google Scholar

New and emerging cardiac technologies in Australian and New Zealand public health services over the next decade [webpage on the Internet]DLA Piper Australia2013 Available from: http://thehub.superu.govt.nz/sites/default/files/43019_DLA_Cardiac_Report_0.pdfAccessed December 12th, 2017

 Google Scholar

AilawadiGLaparDJSpeirAMContemporary Costs Associated With Transcatheter Aortic Valve Replacement: A Propensity-Matched Cost AnalysisAnn Thorac Surg2016101115416126409710

 PubMed Web of Science ®Google Scholar

LindsayACSriharanMLazouraOClinical and economic consequences of non-cardiac incidental findings detected on cardiovascular computed tomography performed prior to transcatheter aortic valve implantation (TAVI)Int J Cardiovasc Imaging20153171435144626068211

 PubMed Web of Science ®Google Scholar

RossiADe CeccoCNKennonSROCT angiography to evaluate coronary artery disease and revascularization requirement before trans-catheter aortic valve replacementJ Cardiovasc Comput Tomogr201711533834628662835

 PubMed Web of Science ®Google Scholar

MwipatayiBPPicardoAMasilonyane-JonesTVIncidence and prognosis of vascular complications after transcatheter aortic valve implantationJ Vasc Surg20135841028103623993436

 PubMed Web of Science ®Google Scholar

PaoneSMiglioreAAbrahaIwebpage on the InternetSutureless aortic valve replacement for aortic valve stenosisRome2015 Available from: http://www.salute.gov.it/imgs/C_17_pagineAree_1202_lista-File_itemName_9_file.pdfAccessed December 12th, 2017

 Google Scholar

Australian Prostheses List (PLAC) [webpage on the Internet] Available from: http://www.health.gov.au/internet/main/publishing.nsf/content/health-about-PLACAccessed December 12th, 2017

 Google Scholar

New Technology Add-On Payment (NTAP) for Perceval [webpage on the Internet] Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2018-IPPS-Final-Rule-Home-Page-Items/FY2018-IPPS-Final-Rule-Regulations.htmlAccessed December 12th, 2017

 Google Scholar

PoveroMPradelliLComparison between traditional and goal directed perfusion in cardiopulmonary by-pass. A differential cost analysis in USFarmeconomia. Health Economics and Therapeutic Pathways20151637786

 Google Scholar

PoveroMPradelliLComparison between traditional and goal directed perfusion in cardiopulmonary by-pass. Adaptation of a differential cost analysisHealth Economics and Therapeutic Pathways201516Supp1 1316

 Google Scholar

Kardaś-SłomaLLucetJCPerozzielloAUniversal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysisBMJ Open2017711e017402

 Web of Science ®Google Scholar

BertiEFortunaDBartoliSI costi di ricovero e follow-up delle procedure di sostituzione valvolare aortica per via percutanea e cardiochirurgica a confronto: analisi secondo le prospettive del Sistema Sanitario Regionale e dell’OspedaleG Ital Cardiol201617Suppl 1S22S30

 Google Scholar

FairbairnTAMeadsDMHulmeCThe cost-effectiveness of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at high operative riskHeart2013991391492023696198

 PubMed Web of Science ®Google Scholar

ThompsonKTaylorCFordeKHammondNThe evolution of Australian intensive care and its related costs: A narrative reviewAust Crit Care201831532533028967466

 PubMed Web of Science ®Google Scholar

MurphyJCHansenPSBhindiRFigtreeGANelsonGIWardMRCost benefit for assessment of intermediate coronary stenosis with fractional flow reserve in public and private sectors in AustraliaHeart Lung Circ201423980781024841388

 PubMed Web of Science ®Google Scholar

WalshTSStanworthSBoydJThe Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost-utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-upHealth Technol Assess201721621118

 Web of Science ®Google Scholar

RayMJBrownKFBurrowsCAO’BrienMFEconomic evaluation of high-dose and low-dose Aprotinin therapy during cardiopulmonary bypassAnn Thorac Surg199968394094510509988

 PubMed Web of Science ®Google Scholar

The Economic Impact of End-Stage Kidney Disease in Australia – Projections to 2020 [webpage on the Internet]Kidney Health Australia (KHA)2010 Available from: http://kidney.org.au/cms_uploads/docs/kha-economic-impact-of-eskd-in-australia-projections-2020.pdfAccessed December 12th, 2017

 Google Scholar

GutmannAKaierKSorgSAnalysis of the additional costs of clinical complications in patients undergoing transcatheter aortic valve replacement in the German Health Care SystemInt J Cardiol201517923123725464455

 PubMed Web of Science ®Google Scholar

FattoreGTorbicaASusiAThe social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness studyBMC Neurol20121213723150894

 PubMed Web of Science ®Google Scholar

DeweyHMThriftAGMihalopoulosCCost of Stroke in Australia From a Societal PerspectiveStroke2001322409241611588334

 PubMed Web of Science ®Google Scholar

BabaliarosVDevireddyCLerakisSComparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): outcomes and cost analysisJACC Cardiovasc Interv20147889890425086843

 PubMed Web of Science ®Google Scholar

DenizHBCaroJJWardAMollerJMalikFEconomic and health consequences of managing bradycardia with dual-chamber compared to single-chamber ventricular pacemakers in ItalyJ Cardiovasc Med2008914350

 Google Scholar

PalmerAJRozeSValentineWJThe CORE Diabetes Model: Projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-makingCurr Med Res Opin200420Suppl 1S5S26

 PubMed Web of Science ®Google Scholar

IcksAHaastertBGandjourACosts of dialysis--a regional population-based analysisNephrol Dial Transplant20102551647165220008830

 PubMed Web of Science ®Google Scholar

RayJAValentineWJSecnikKReview of the cost of diabetes complications in Australia, Canada, France, Germany, Italy and SpainCurr Med Res Opin200521101617162916238902

 PubMed Web of Science ®Google Scholar

RoggeriARoggeriDPZocchettiCHealthcare costs of the progression of chronic kidney disease and different dialysis techniques estimated through administrative database analysisJ Nephrol201730226326927165160

 PubMed Web of Science ®Google Scholar

LiBCairnsJAFotheringhamJUnderstanding cost of care for patients on renal replacement therapy: looking beyond fixed tariffsNephrol Dial Transplant201530101726173426071229

 PubMed Web of Science ®Google Scholar

HowardKSalkeldGWhiteSThe cost-effectiveness of increasing kidney transplantation and home-based dialysisNephrology200914112313219207859

 PubMed Web of Science ®Google Scholar

MercaldiCJSiuKSanderSDLong-Term Costs of Ischemic Stroke and Major Bleeding Events among Medicare Patients with Nonvalvular Atrial FibrillationCardiol Res Pract2012201264546923082276

 PubMedGoogle Scholar

Penaloza-RamosMCJowettSBartonPCost-effectiveness analysis of different systolic blood pressure targets for people with a history of stroke or transient ischaemic attack: Economic analysis of the PAST-BP studyEur J Prev Cardiol201623151590159827226338

 PubMed Web of Science ®Google Scholar

RinfretSCohenDJLamasGACost-effectiveness of dual-chamber pacing compared with ventricular pacing for sinus node dysfunctionCirculation2005111216517215630030

 PubMed Web of Science ®Google Scholar

WiegandUKPotratzJBodeFCost-effectiveness of dual-chamber pacemaker therapy: does single lead VDD pacing reduce treatment costs of atrioventricular block?Eur Heart J200122217418011161919

 PubMed Web of Science ®Google Scholar

FagnaniFLitzlerPYEltchaninofHCost-effectiveness of trans-catheter aortic valve implantation in high-risk patients with symptomatic aortic valve stenosis in FranceValue Health2009127A328

 Web of Science ®Google Scholar

EdwardsSJKarnerCTrevorNDual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluationHealth Technology Assessment (HTA)201519651210

 Web of Science ®Google Scholar

TaylorCJMonahanMRoalfeAKBartonPIlesRHobbsFDRThe REFER (REFer for EchocaRdiogram) study: a prospective validation and health economic analysis of a clinical decision rule, NT-proBNP or their combination in the diagnosis of heart failure in primary careEME201743156

 Google Scholar

Bravo VergelYPalmerSAsseburgCIs primary angioplasty cost effective in the UK? Results of a comprehensive decision analysisHeart200793101238124317717037

 PubMed Web of Science ®Google Scholar

PradelliLZanioloOPerceval Sutureless valves in isolated and concomitant AVR procedures: an economic model shows overall decrease of costs for isolated or combined operationsFarmeconomia. Health economics and therapeutic pathways2012134159174

 Google Scholar

ShresthaMFischleinTMeurisBEuropean multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes up to 5 years in over 700 patientsEur J Cardiothorac Surg201649123424125750010

 PubMed Web of Science ®Google Scholar

AuffretVLefevreTVan BelleETemporal Trends in Transcatheter Aortic Valve Replacement in France: FRANCE 2 to FRANCE TAVIJ Am Coll Cardiol2017701425528662806

 PubMed Web of Science ®Google Scholar