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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

Expert review of pharmacoeconomics & outcomes research(2023)SCI 4区

Univ York | Edwards Lifesci SA | Syenza | St Bartholomews Hosp London | New Cross Hosp | London Hosp

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Abstract
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.
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Surgical aortic valve replacement,bioprosthetic valve,aortic stenosis,health economics,cost-effectiveness,NHS
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要点】:本研究探讨了新型组织瓣膜与机械瓣膜在英国55-64岁和65岁以上患有主动脉狭窄的病人中进行手术主动脉瓣置换的成本效益,结果显示新型组织瓣膜可能更具成本效益。

方法】:研究使用决策分析模型,并采用分割生存模型,利用已发表文献获取参数输入,并进行了确定性敏感度分析和概率敏感性分析。

实验】:研究通过模型分析得出,新型组织瓣膜相比机械瓣膜能为每个病人增加0.01的质量调整生命年(QALYs),在55-64岁年龄组中具有最大的潜在成本节省(£408),而在65岁以上组别中节省为£53。敏感性分析表明结果高度依赖于全因死亡率、手术成本和再次手术率的相对差异。在£20,000每QALY的成本效益阈值下,55-64岁年龄组约有75%的概率是成本效益的,65岁以上组别为57%。未提及具体的数据集名称。