LBI-HTA reviews patient selection practice for TAVI in Austria

Transcatheter Aortic Valve Implantation (TAVI) has been used for the treatment of patients with severe, symptomatic aortic stenosis for several years. It is a less invasive but high-cost alternative to surgical aortic valve replacement with open heart surgery.

The Ludwig Boltzmann Institute – Health Technology Assessment (LBI-HTA) is an independent research institution supporting evidence-based and cost-efficient decision-making in Austria. LBI-HTA now performed a systematic review of health economic evaluations of TAVI.

Purpose of the report by LBI-HTA was to review the current policy for selection of patients for TAVI in Austria. For this, health-economic evaluations on the cost-effectiveness of TAVI for patients who are inoperable or operable but with high or moderate surgical risk were investigated.

In the review, LBI-HTA identified a total of 15 health-economic analyses published in English and German between 2007 and 2017. Out of these, 8 studies were assessed with sufficient relevance and quality. The results showed that, for inoperable patients, TAVI was cost-effective compared to Medical Management (1 study). For operable patients, TAVI was cost-effective compared to Standard Management in only 1 of 5 studies and showed controversial results compared to Surgical Aortic Valve Replacement in patients with high surgical risk (4 studies). Sensitivity analyses showed that the results may particularly be influenced by the inclusion of follow-up treatments such as stroke and the TAVI procedure costs.

The LBI-HTA concluded that the cost-effectiveness results are only partially transferable to Austria for following reasons:

• Only a small number (8 of 15) of evaluations were sufficiently reliable
• Low robustness of the cost-effectiveness results, as they are highly sensitive to in- and exclusion of cost parameters
• Austria does not use cost-effectiveness thresholds

Overall, LBI-HTA concludes that the current policy in Austria of selecting patients for TAVI based on clinical parameters can be considered as good practice.

The report by the LBI-HTA is available in German here.

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