TAVI in patients with intermediate surgical risk assessed in Norway

In June 2019, the Norwegian Institute of Public Health (NIPH) has released a health technology assessment report for transcatheter aortic valve implantation (TAVI) as a treatment for patients with severe aortic stenosis and intermediate surgical risk. This assessment was initially commissioned to NIPH by the National System for Managed Introduction of New Health Technologies within the Specialist Health Service in Norway (Nye Metoder) in order to assess the cost-effectiveness of TAVI for patients with severe aortic stenosis and intermediate surgical risk compared with open surgery against the priority criteria applicable in Norway.

The following results were obtained by NIPH:

• The cost-utility analysis indicated that TAVI was slightly more effective (in terms of 0.07 quality-adjusted-life-years (QALY) gain) and more costly (in terms of incremental costs of 71 000 Norwegian kroner) than the open surgery. These results were robust to variations in assumption about the time perspective
• The incremental cost-effectiveness ratio (ICER) was about 1.04 million Norwegian kroner per QALY in analysis with two-years perspective, falling to about 800,000 Norwegian kroner per QALY in a lifetime perspective
• The results of the sensitivity analysis of the current model analysis showed that cost parameters related to the TAVI procedure had the most significant impact on the results (ICER)
• NIPH performed an analysis quantifying the severity criterion by calculating absolute shortfall for patients with severe aortic stenosis and intermediate surgical risk. The results show the absolute gap of 3.6 QALYs
• The budget impact analysis based on the results of the current cost-effectiveness analysis and some conservative assumptions about expansion in the use of TAVI indicates that the incremental annual total cost of this expansion will reach 32.5 million Norwegian kroner in the course of five years

These findings can help decision makers appraise the intervention against the official priority setting criteria in health care sector applicable in Norway.

See the full health technology assessment report in English and Norwegian here.

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