BACKGROUND Transcatheter Aortic Valve Implantation(TAVI) has been shown to provide comparable survival benefit and improvement in quality of life to surgical aortic valve replacement(SAVR) for treating patients with s...BACKGROUND Transcatheter Aortic Valve Implantation(TAVI) has been shown to provide comparable survival benefit and improvement in quality of life to surgical aortic valve replacement(SAVR) for treating patients with severe aortic stenosis(AS) at intermediate surgical risk.This study aimed to evaluate the cost-utility of TAVI compared with SAVR for severe aortic stenosis with interme diate surgical risk in Thailand.METHODS A two-part constructed model was used to analyze lifetime costs and quality-adjusted life-years(QALYs) from societal and healthcare perspectives.The study cohort comprised severe AS patients at intermediate surgical risk with an average age of 80 years.The landmark trials were used to populate the model in terms of mortality and adverse event rates.All cost-related data and quality of life were based on Thai population.Costs and QALYs were discounted at 3% armually and presented as2021 values.Incremental cost-effectiveness ratios(ICERs) were calculated.Deterministic and probabilistic sensitivity analyses were conducted.RESULTS In comparison to SAVR,TAVI resulted in higher total cost(THB 1,717,132 [USD 52;415.51] vs.THB 893,524 [USD27,274.84]) and higher QALYs(4.88 vs.3.98) in a societal perspective.The estimated ICER was THB 906,937/QALY(USD27,684.27/QALY).From a healthcare system perspective,TAVI also had higher total cost than SAVR(THB 1,573,751 [USD48,038.79] vs.THB 726,342 [USD 22,171.63]) with similar QALYs gained to the societal perspective.The estimated ICER was THB933,145/QALY(USD 933,145/QALY).TAVI was not cost-effective at the Thai willingness to pay(WTP) threshold of THB160,000/QALY(USD 4,884/QALY).The results were sensitive to utility of either SAVR or TAVI treatment and cost of TAVI valve.CONCLUSION In patients with severe AS at intermediate surgical risk,TAVI is not a cost-effective strategy compared with SAVR at the WTP of THB 160;000/QALY(USD 4,884/QALY) from the perspectives of society and healthcare system.展开更多
Background:Studies on predictors of health-related quality of life(HRQOL)in pediatric patients with cyanotic heart disease who are waiting for the next stage and those who have undergone total repair are scarce.Theref...Background:Studies on predictors of health-related quality of life(HRQOL)in pediatric patients with cyanotic heart disease who are waiting for the next stage and those who have undergone total repair are scarce.Therefore,we aimed to identify such predictors in children who received the modified Blalock–Taussig shunt(MBTS)and those who underwent total repair.Methods:In this historical cohort and concurrent follow-up study,data of children who underwent MBTS at the age of 0–3 years between January 2005 and December 2016 at a super-tertiary care hospital in Southern Thailand were obtained.Children who were alive in December 2017 were recruited to evaluate the quality of life at least 1 year after their operation.Between January and December 2018,the“Pediatric Quality of Life Inventory 4.0 Generic Core Scales”with both child self-report and parent proxy-report scores were used to examine the HRQOL.Multivariate linear regression analysis was performed to identify independent predictors of HRQOL.Beta-coefficient(β)and 95% confidence intervals(95%CIs)were calculated and considered statistically significant at p<0.05.Results:Among the 380 enrolled children,148 died,122 survived and waited for total repair,and 110 survived after total repair.In the multivariate analysis,chronic lung disease was a common predictor of lower physical and psychosocial HRQOL reported by the parents(β[95%CI]:−0.42[−0.81,−0.03]and−0.49[−0.89,−0.09],respectively).Total repair was a predictor of higher physical HRQOL according to both parents and children(β[95%CI]:0.33[0.09,0.57]and 0.70[0.36,1.03],respectively).A predictor of higher psychosocial HRQOL reported by the parents was younger age during MBTS surgery compared with older age(β[95%CI]:0.012[0.001,0.022]).In the total repair subgroup,undergoing the Fontan procedure(vs.Glenn procedure)was a predictor for lower physical HRQOL reported by the parents(β[95%CI]:−0.82[−1.52,−0.13]).Higher socioeconomic status was a predictor of both physical and psychosocial HRQOL(β[95%CI]:0.018[0.001,0.034]and 0.012[0.0001,0.04],respectively).Conclusions:Successful total repair was a predictor of higher physical HRQOL,and younger age during MBTS surgery was a predictor of higher psychological HRQOL in children with cyanotic heart disease.Higher socioeconomic status was a predictor of both physical and psychological HRQOL following total repair[Thai Clinical Trials Registry:TCTR20161221003].展开更多
基金supported by a grant from the Health Systems Research Institute (Thailand)
文摘BACKGROUND Transcatheter Aortic Valve Implantation(TAVI) has been shown to provide comparable survival benefit and improvement in quality of life to surgical aortic valve replacement(SAVR) for treating patients with severe aortic stenosis(AS) at intermediate surgical risk.This study aimed to evaluate the cost-utility of TAVI compared with SAVR for severe aortic stenosis with interme diate surgical risk in Thailand.METHODS A two-part constructed model was used to analyze lifetime costs and quality-adjusted life-years(QALYs) from societal and healthcare perspectives.The study cohort comprised severe AS patients at intermediate surgical risk with an average age of 80 years.The landmark trials were used to populate the model in terms of mortality and adverse event rates.All cost-related data and quality of life were based on Thai population.Costs and QALYs were discounted at 3% armually and presented as2021 values.Incremental cost-effectiveness ratios(ICERs) were calculated.Deterministic and probabilistic sensitivity analyses were conducted.RESULTS In comparison to SAVR,TAVI resulted in higher total cost(THB 1,717,132 [USD 52;415.51] vs.THB 893,524 [USD27,274.84]) and higher QALYs(4.88 vs.3.98) in a societal perspective.The estimated ICER was THB 906,937/QALY(USD27,684.27/QALY).From a healthcare system perspective,TAVI also had higher total cost than SAVR(THB 1,573,751 [USD48,038.79] vs.THB 726,342 [USD 22,171.63]) with similar QALYs gained to the societal perspective.The estimated ICER was THB933,145/QALY(USD 933,145/QALY).TAVI was not cost-effective at the Thai willingness to pay(WTP) threshold of THB160,000/QALY(USD 4,884/QALY).The results were sensitive to utility of either SAVR or TAVI treatment and cost of TAVI valve.CONCLUSION In patients with severe AS at intermediate surgical risk,TAVI is not a cost-effective strategy compared with SAVR at the WTP of THB 160;000/QALY(USD 4,884/QALY) from the perspectives of society and healthcare system.
基金This work was funded by the Faculty of Medicine, Prince of Songkla University,Hat Yai, Songkhla, Thailand. M.O. received a grant amount of B| 70,320 in January 2017 (Grant No.59-301-08-01http://medinfo.psu.ac.th/)
文摘Background:Studies on predictors of health-related quality of life(HRQOL)in pediatric patients with cyanotic heart disease who are waiting for the next stage and those who have undergone total repair are scarce.Therefore,we aimed to identify such predictors in children who received the modified Blalock–Taussig shunt(MBTS)and those who underwent total repair.Methods:In this historical cohort and concurrent follow-up study,data of children who underwent MBTS at the age of 0–3 years between January 2005 and December 2016 at a super-tertiary care hospital in Southern Thailand were obtained.Children who were alive in December 2017 were recruited to evaluate the quality of life at least 1 year after their operation.Between January and December 2018,the“Pediatric Quality of Life Inventory 4.0 Generic Core Scales”with both child self-report and parent proxy-report scores were used to examine the HRQOL.Multivariate linear regression analysis was performed to identify independent predictors of HRQOL.Beta-coefficient(β)and 95% confidence intervals(95%CIs)were calculated and considered statistically significant at p<0.05.Results:Among the 380 enrolled children,148 died,122 survived and waited for total repair,and 110 survived after total repair.In the multivariate analysis,chronic lung disease was a common predictor of lower physical and psychosocial HRQOL reported by the parents(β[95%CI]:−0.42[−0.81,−0.03]and−0.49[−0.89,−0.09],respectively).Total repair was a predictor of higher physical HRQOL according to both parents and children(β[95%CI]:0.33[0.09,0.57]and 0.70[0.36,1.03],respectively).A predictor of higher psychosocial HRQOL reported by the parents was younger age during MBTS surgery compared with older age(β[95%CI]:0.012[0.001,0.022]).In the total repair subgroup,undergoing the Fontan procedure(vs.Glenn procedure)was a predictor for lower physical HRQOL reported by the parents(β[95%CI]:−0.82[−1.52,−0.13]).Higher socioeconomic status was a predictor of both physical and psychosocial HRQOL(β[95%CI]:0.018[0.001,0.034]and 0.012[0.0001,0.04],respectively).Conclusions:Successful total repair was a predictor of higher physical HRQOL,and younger age during MBTS surgery was a predictor of higher psychological HRQOL in children with cyanotic heart disease.Higher socioeconomic status was a predictor of both physical and psychological HRQOL following total repair[Thai Clinical Trials Registry:TCTR20161221003].
