Budget Impact Analysis tra due valvole aortiche transcatetere per TAVI

DOI 10.23753/htafocus2018.02.008

Greta Mangoni, Francesca Cammalleri, Laura Camuffo, Cinzia Veneziano, Chiara Parati, Marta Dall’Aglio, Angela Luoni


Background Aortic stenosis (SA) is a common valvulopathy in elderly patients which present a poor prognosis after the first symptoms (average survival 2-5 years). Trans-catheter aortic valve implantation (TAVI) is indicated in patients with ineffective or medium/high-risk severe symptomatic SA. CoreValve™Evolut™R and Portico™ are the two devices used in Niguarda Hospital for this kind of implantation. This study aims to carry out a budget impact analysis (BIA) to evaluate the cost-effectiveness between the two bioprosthesis.
Materials and methods Systematic literature review and comparison between the data sheets were conducted to underline differences in technical characteristics between CoreValve™Evolut™ R and Portico™. To provide information about the various use, implantation and handling the clinician has been interviewed. Thanks to data related to consumptions and costs collected from 2013 to 2016, different price settings have been hypothesized during the period 2017-2019.
Results According to the available literature, CoreValve™Evolut™R involved a pacemaker implant in 12% of cases, while Portico™ in 10%. The clinician preferred CoreValve™Evolut™R in patients with calcific valve, while Portico™ in patients with coronary diseases and for all other types of patients. In 2016, with the introduction of Portico™, there was a reduction in the use of CoreValve™Evolut™R. This volume-trend was supposed to be stable in the period 2017-2019.
BIA showed the same direct hospital costs for the two devices except for the valve’s price: Portico™ was more expensive than € 2.390,91.
Three price trends were expected: the maintenance of the difference of costs between the two devices, at high probability; the strong reduction of CoreValve™Evolut™R’s price, at medium probability; the price parity, at low probability. Based on the consolidated data of 2017, the trend seems to go towards the price parity.
Conclusions Actually, Portico™ has become more advantageous for the hospital thanks to both the clinical advantages related to the broad profile of eligible patients and tolerability, and to an aggressive discount, which grows with the increase in the number of valves implanted, and which canceled the cost differential between the two valves.

Key words: Budget Impact Analysis, Portico, CoreValve, Trans-catheter aortic valve implantation