Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden
Keywords:
Transcatheter aortic valve implantation, surgical aortic valve replacement, cost-effectiveness, aortic stenosis, low risk
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has shown similar or improved clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis at low risk for surgical mortality. This cost-utility analysis compared TAVI with SAPIEN 3 versus SAVR in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of the Swedish healthcare system.
Methods: A published, two-stage, Markov-based cost-utility model that captured clinical outcomes from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated according to Recommended Therapies (SWEDEHEART) registry (2018–2020) was adapted from the perspective of the Swedish healthcare system using local general population mortality, utility and costs data. The model had a lifetime horizon. Model outputs included changes in direct healthcare costs and health-related quality of life from using TAVI as compared with SAVR.
Results: TAVI with SAPIEN 3 resulted in lifetime costs per patient of 940,541 Swedish krona (SEK) and lifetime quality-adjusted life years (QALYs) per patient of 7.16, whilst SAVR resulted in lifetime costs and QALYs per patient of 821,380 SEK and 6.81 QALYs, respectively. Compared with SAVR, TAVI offered an incremental improvement of +0.35 QALY per patient at an increased cost of +119,161 SEK per patient over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of 343,918 SEK per QALY gained.
Conclusion: TAVI with SAPIEN 3 is a cost-effective option versus SAVR for patients with symptomatic severe aortic stenosis at low risk for surgical mortality treated in the Swedish healthcare setting. These findings may inform policy decisions in Sweden for the management of this patient group.
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References
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7. Beyersdorf F, Vahanian A, Milojevic M, Praz F, Baldus S, Bauersachs J, et al. Erratum to: 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardio Thorac Surg. 2022;61:964. doi: 10.1093/ejcts/ezab557
8. Leon MB, Mack MJ, Hahn RT, Thourani VH, Makkar R, Kodali SK, et al. Outcomes 2 years after transcatheter aortic valve replacement in patients at low surgical risk. J Am Coll Cardiol. 2021;77:1149–61. doi: 10.1016/j.jacc.2020.12.052
9. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695–705. doi: 10.1056/NEJMoa1814052
10. Mack MJ, Leon MB, Thourani VH, Pibarot P, Hahn RT, Genereux P, et al. Transcatheter aortic-valve replacement in low-risk patients at five years. N Engl J Med. 2023;389:1949–60. doi: 10.1056/NEJMoa2307447
11. Reynolds MR, Magnuson EA, Wang K, Lei Y, Vilain K, Walczak J, et al. Cost-effectiveness of transcatheter aortic valve replacement compared with standard care among inoperable patients with severe aortic stenosis: results from the placement of aortic transcatheter valves (PARTNER) trial (Cohort B). Circulation. 2012;125:1102–9. doi: 10.1161/CIRCULATIONAHA.111.054072
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13. Thyregod HGH, Ihlemann N, Jorgensen TH, Nissen H, Kjeldsen BJ, Petursson P, et al. Five-year clinical and echocardiographic outcomes from the Nordic Aortic Valve Intervention (NOTION) randomized clinical trial in lower surgical risk patients. Circulation. 2019;139:2714–23. doi: 10.1161/CIRCULATIONAHA.118.036606
14. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561–632. doi: 10.1093/eurheartj/ehab395
15. Gilard M, Eltchaninoff H, Iung B, Lefèvre T, Spaulding C, Dumonteil N, et al. Cost-effectiveness analysis of SAPIEN 3 transcatheter aortic valve implantation procedure compared with surgery in patients with severe aortic stenosis at low risk of surgical mortality in France. Value Health. 2022;25:605–13. doi: 10.1016/j.jval.2021.10.003
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17. Pinar E, García de Lara J, Hurtado J, Robles M, Leithold G, Martí-Sánchez B, et al. Cost-effectiveness analysis of the SAPIEN 3 transcatheter aortic valve implant in patients with symptomatic severe aortic stenosis. Rev Esp Cardiol (English ed). 2022;75:325–33. doi: 10.1016/j.recesp.2021.02.006
18. Kuck KH, Leidl R, Frankenstein L, Wahlers T, Sarmah A, Candolfi P, et al. Cost-effectiveness of SAPIEN 3 transcatheter aortic valve implantation versus surgical aortic valve replacement in German severe aortic stenosis patients at low surgical mortality risk. Adv Ther. 2023;40:1031–46. doi: 10.1007/s12325-022-02392-y
19. Dubois C, Adriaenssens T, Annemans L, Bosmans J, Callebaut B, Candolfi P, et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement in severe aortic stenosis patients at low surgical mortality risk: a cost-effectiveness analysis in Belgium. Acta Cardiol. 2024;79:46–57. doi: 10.1080/00015385.2023.2282283
20. Dasari M, Cook J, Dhankhar P. Economic model and methodologies employed in recent nice single technology appraisal submissions. Value Health. 2019;22:S800–1. doi: 10.1016/j.jval.2019.09.2133
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24. Burström K, Johannesson M, Diderichsen F. A comparison of individual and social time trade-off values for health states in the general population. Health Policy. 2006;76:359–70. doi: 10.1016/j.healthpol.2005.06.011
25. Nilsson K, Buccheri S, Christersson C, Koul S, Nilsson J, Pétursson P, et al. Causes, pattern, predictors, and prognostic implications of new hospitalizations after transcatheter aortic valve implantation: a long-term nationwide observational study. Eur Heart J Qual Care Clin Outcomes. 2022;8:150–60. doi: 10.1093/ehjqcco/qcab026
26. Vikholm P, Ivert T, Nilsson J, Holmgren A, Freter W, Ternström L, et al. Validity of the Swedish Cardiac Surgery Registry. Interact Cardiovasc Thorac Surg. 2018;27:67–74. doi: 10.1093/icvts/ivy030
27. National life tables Sweden. 2022. Available from: https://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__BE__BE0101__BE0101I/LivslangdEttariga/table/tableViewLayout1/ [cited September 2023].
28. Odutayo A, Wong CX, Hsiao AJ, Hopewell S, Altman DG, Emdin CA. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016;354:i4482. doi: 10.1136/bmj.i4482
29. Dennis MS, Burn JP, Sandercock PA, Bamford JM, Wade DT, Warlow CP. Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke. 1993;24:796–800. doi: 10.1161/01.STR.24.6.796
30. Hallberg S, Gandra SR, Fox KM, Mesterton J, Banefelt J, Johansson G, et al. Healthcare costs associated with cardiovascular events in patients with hyperlipidaemia or prior cardiovascular events: estimates from Swedish population-based register data. Eur J Health Econ. 2016;17:591–601. doi: 10.1007/s10198-015-0702-0
31. Lanitis T, Kongnakorn T, Jacobson L, De Geer A. Cost-effectiveness of apixaban versus warfarin and aspirin in Sweden for stroke prevention in patients with atrial fibrillation. Thromb Res. 2014;134:278–87. doi: 10.1016/j.thromres.2014.05.027
32. Wittboldt S, Leosdottir M, Ravn Fischer A, Ekman B, Bäck M. Exercise-based cardiac rehabilitation after acute myocardial infarction in Sweden – standards, costs, and adherence to European guidelines (The Perfect-CR study). Physiother Theory Pract. 2024;40(2):366–76. doi: 10.1080/09593985.2022.2114052
33. Sullivan PW, Slejko JF, Sculpher MJ. Catalogue of EQ-5D scores for the United Kingdom. Med Decis Making. 2011;31:800–4. doi: 10.1177/0272989X11401031
34. Siverskog J, Henriksson M. On the role of cost-effectiveness thresholds in healthcare priority setting. Int J Technol Assess Healthcare. 2021;37:e23. doi: 10.1017/S0266462321000015
35. Shahim B, Malaisrie SC, George I, Thourani VH, Biviano AB, Russo M, et al. Postoperative atrial fibrillation or flutter following transcatheter or surgical aortic valve replacement: PARTNER 3 trial. JACC Cardiovasc Interv. 2021;14:1565–74. doi: 10.1016/j.jcin.2021.05.026
36. Heathcote L, Srivastava T, Sarmah A, Kearns B, Sutton A, Candolfi P. A systematic review and statistical analysis of factors influencing the cost-effectiveness of transcatheter aortic valve implantation for symptomatic severe aortic stenosis. Clinicoecon Outcomes Res. 2023;15:459–75. doi: 10.2147/CEOR.S392566
37. Polak TB, Cucchi DGJ, Darrow JJ, Versteegh MM. Incremental benefits of novel pharmaceuticals in the UK: a cross-sectional analysis of NICE technology appraisals from 2010 to 2020. BMJ Open. 2022;12(4):e058279. doi: 10.1136/bmjopen-2021-058279
38. Wisløff T, Hagen G, Hamidi V, Movik E, Klemp M, Olsen JA. Estimating QALY gains in applied studies: a review of cost-utility analyses published in 2010. Pharmacoeconomics. 2014;32:367–75. doi: 10.1007/s40273-014-0136-z
39. HAS-Sante. SAPIEN 3 treatment of severe symptomatic aortic stenosis in low-risk surgical patients in France. 2021. Available from: https://www.has-sante.fr/upload/docs/application/pdf/2021-04/sapien3_9022021_avis_economique_vf2.pdf [cited September 2023].
40. Norwegian Institute of Public Health (NIPH). Transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis and low surgical risk and across surgical risk groups: a health technology assessment. 2021. Available from: https://www.fhi.no/en/publ/2021/TAVI-vs-SAVR-for-patients-with-severe-aortic-stenosis-and-low-surgical-risk-and-across-surgical-risk-groups/ [cited September 2023].
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42. Zhou JY, Liew D, Duffy SJ, Walton A, Htun N, Stub D. Cost-effectiveness of transcatheter versus surgical aortic valve replacement in low-risk patients with severe aortic stenosis. Heart Lung Circ. 2021;30:547–54. doi: 10.1016/j.hlc.2020.09.934
43. Tam DY, Azizi PM, Fremes SE, Chikwe J, Gaudino M, Wijeysundera HC. The cost-effectiveness of transcatheter aortic valve replacement in low surgical risk patients with severe aortic stenosis. Eur Heart J Qual Care Clin Outcomes. 2021;7:556–63. doi: 10.1093/ehjqcco/qcaa058
44. Lytvyn L, Guyatt GH, Manja V, Siemieniuk RA, Zhang Y, Agoritsas T, et al. Patient values and preferences on transcatheter or surgical aortic valve replacement therapy for aortic stenosis: a systematic review. BMJ Open. 2016;6:e014327. doi: 10.1136/bmjopen-2016-014327
45. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450. doi: 10.1186/1471-2458-11-450
46. Kostnad per patient (KPP). Available from: https://skr.se/skr/halsasjukvard/ekonomiavgifter/kostnadperpatientkpp.1076.html [cited April 2024].
2. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609–20. doi: 10.1056/NEJMoa1514616
3. Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardio Thorac Surg. 2017;52:616–64. doi: 10.1093/ejcts/ezx324
4. Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG, et al. Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med. 2020;382:799–809. doi: 10.1056/NEJMoa1910555
5. Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, Mumtaz M, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2017;376:1321–31. doi: 10.1056/NEJMoa1700456
6. Jernberg T, Attebring MF, Hambraeus K, Ivert T, James S, Jeppsson A, et al. The Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART). Heart. 2010;96:1617–21. doi: 10.1136/hrt.2010.198804
7. Beyersdorf F, Vahanian A, Milojevic M, Praz F, Baldus S, Bauersachs J, et al. Erratum to: 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardio Thorac Surg. 2022;61:964. doi: 10.1093/ejcts/ezab557
8. Leon MB, Mack MJ, Hahn RT, Thourani VH, Makkar R, Kodali SK, et al. Outcomes 2 years after transcatheter aortic valve replacement in patients at low surgical risk. J Am Coll Cardiol. 2021;77:1149–61. doi: 10.1016/j.jacc.2020.12.052
9. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695–705. doi: 10.1056/NEJMoa1814052
10. Mack MJ, Leon MB, Thourani VH, Pibarot P, Hahn RT, Genereux P, et al. Transcatheter aortic-valve replacement in low-risk patients at five years. N Engl J Med. 2023;389:1949–60. doi: 10.1056/NEJMoa2307447
11. Reynolds MR, Magnuson EA, Wang K, Lei Y, Vilain K, Walczak J, et al. Cost-effectiveness of transcatheter aortic valve replacement compared with standard care among inoperable patients with severe aortic stenosis: results from the placement of aortic transcatheter valves (PARTNER) trial (Cohort B). Circulation. 2012;125:1102–9. doi: 10.1161/CIRCULATIONAHA.111.054072
12. Neyt M, Van Brabandt H, Devriese S, Van De Sande S. A cost-utility analysis of transcatheter aortic valve implantation in Belgium: focusing on a well-defined and identifiable population. BMJ Open. 2012;2:e001032. doi: 10.1136/bmjopen-2012-001032
13. Thyregod HGH, Ihlemann N, Jorgensen TH, Nissen H, Kjeldsen BJ, Petursson P, et al. Five-year clinical and echocardiographic outcomes from the Nordic Aortic Valve Intervention (NOTION) randomized clinical trial in lower surgical risk patients. Circulation. 2019;139:2714–23. doi: 10.1161/CIRCULATIONAHA.118.036606
14. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561–632. doi: 10.1093/eurheartj/ehab395
15. Gilard M, Eltchaninoff H, Iung B, Lefèvre T, Spaulding C, Dumonteil N, et al. Cost-effectiveness analysis of SAPIEN 3 transcatheter aortic valve implantation procedure compared with surgery in patients with severe aortic stenosis at low risk of surgical mortality in France. Value Health. 2022;25:605–13. doi: 10.1016/j.jval.2021.10.003
16. Mennini FS, Meucci F, Pesarini G, Vandoni P, Lettino M, Sarmah A, et al. Cost-effectiveness of transcatheter aortic valve implantation versus surgical aortic valve replacement in low surgical risk aortic stenosis patients. Int J Cardiol. 2022;357:26–32. doi: 10.1016/j.ijcard.2022.03.034
17. Pinar E, García de Lara J, Hurtado J, Robles M, Leithold G, Martí-Sánchez B, et al. Cost-effectiveness analysis of the SAPIEN 3 transcatheter aortic valve implant in patients with symptomatic severe aortic stenosis. Rev Esp Cardiol (English ed). 2022;75:325–33. doi: 10.1016/j.recesp.2021.02.006
18. Kuck KH, Leidl R, Frankenstein L, Wahlers T, Sarmah A, Candolfi P, et al. Cost-effectiveness of SAPIEN 3 transcatheter aortic valve implantation versus surgical aortic valve replacement in German severe aortic stenosis patients at low surgical mortality risk. Adv Ther. 2023;40:1031–46. doi: 10.1007/s12325-022-02392-y
19. Dubois C, Adriaenssens T, Annemans L, Bosmans J, Callebaut B, Candolfi P, et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement in severe aortic stenosis patients at low surgical mortality risk: a cost-effectiveness analysis in Belgium. Acta Cardiol. 2024;79:46–57. doi: 10.1080/00015385.2023.2282283
20. Dasari M, Cook J, Dhankhar P. Economic model and methodologies employed in recent nice single technology appraisal submissions. Value Health. 2019;22:S800–1. doi: 10.1016/j.jval.2019.09.2133
21. Komorowski M, Raffa J. Markov Models and Cost Effectiveness Analysis: Applications in Medical Research. In: Critical Data MIT, ed. Secondary analysis of electronic health records. Cham (CH): Springer International Publishing; 2016, pp. 351–67.
22. Abbott JH, Wilson R, Pryymachenko Y, Sharma S, Pathak A, Chua JYY. Economic evaluation: a reader’s guide to studies of cost‑effectiveness. Arch Physiother. 2022;12(1):28. doi: 10.1186/s40945-022-00154-1
23. TVLR Guidelines. Tandvårds- och läkemedelsförmånsverkets allmänna råd. 2017. TLVAR 2017:1. Available from: https://www.tlv.se/download/18.467926b615d084471ac3230c/1510316374332/TLVAR_2017_1.pdf [cited June 2024].
24. Burström K, Johannesson M, Diderichsen F. A comparison of individual and social time trade-off values for health states in the general population. Health Policy. 2006;76:359–70. doi: 10.1016/j.healthpol.2005.06.011
25. Nilsson K, Buccheri S, Christersson C, Koul S, Nilsson J, Pétursson P, et al. Causes, pattern, predictors, and prognostic implications of new hospitalizations after transcatheter aortic valve implantation: a long-term nationwide observational study. Eur Heart J Qual Care Clin Outcomes. 2022;8:150–60. doi: 10.1093/ehjqcco/qcab026
26. Vikholm P, Ivert T, Nilsson J, Holmgren A, Freter W, Ternström L, et al. Validity of the Swedish Cardiac Surgery Registry. Interact Cardiovasc Thorac Surg. 2018;27:67–74. doi: 10.1093/icvts/ivy030
27. National life tables Sweden. 2022. Available from: https://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__BE__BE0101__BE0101I/LivslangdEttariga/table/tableViewLayout1/ [cited September 2023].
28. Odutayo A, Wong CX, Hsiao AJ, Hopewell S, Altman DG, Emdin CA. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016;354:i4482. doi: 10.1136/bmj.i4482
29. Dennis MS, Burn JP, Sandercock PA, Bamford JM, Wade DT, Warlow CP. Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke. 1993;24:796–800. doi: 10.1161/01.STR.24.6.796
30. Hallberg S, Gandra SR, Fox KM, Mesterton J, Banefelt J, Johansson G, et al. Healthcare costs associated with cardiovascular events in patients with hyperlipidaemia or prior cardiovascular events: estimates from Swedish population-based register data. Eur J Health Econ. 2016;17:591–601. doi: 10.1007/s10198-015-0702-0
31. Lanitis T, Kongnakorn T, Jacobson L, De Geer A. Cost-effectiveness of apixaban versus warfarin and aspirin in Sweden for stroke prevention in patients with atrial fibrillation. Thromb Res. 2014;134:278–87. doi: 10.1016/j.thromres.2014.05.027
32. Wittboldt S, Leosdottir M, Ravn Fischer A, Ekman B, Bäck M. Exercise-based cardiac rehabilitation after acute myocardial infarction in Sweden – standards, costs, and adherence to European guidelines (The Perfect-CR study). Physiother Theory Pract. 2024;40(2):366–76. doi: 10.1080/09593985.2022.2114052
33. Sullivan PW, Slejko JF, Sculpher MJ. Catalogue of EQ-5D scores for the United Kingdom. Med Decis Making. 2011;31:800–4. doi: 10.1177/0272989X11401031
34. Siverskog J, Henriksson M. On the role of cost-effectiveness thresholds in healthcare priority setting. Int J Technol Assess Healthcare. 2021;37:e23. doi: 10.1017/S0266462321000015
35. Shahim B, Malaisrie SC, George I, Thourani VH, Biviano AB, Russo M, et al. Postoperative atrial fibrillation or flutter following transcatheter or surgical aortic valve replacement: PARTNER 3 trial. JACC Cardiovasc Interv. 2021;14:1565–74. doi: 10.1016/j.jcin.2021.05.026
36. Heathcote L, Srivastava T, Sarmah A, Kearns B, Sutton A, Candolfi P. A systematic review and statistical analysis of factors influencing the cost-effectiveness of transcatheter aortic valve implantation for symptomatic severe aortic stenosis. Clinicoecon Outcomes Res. 2023;15:459–75. doi: 10.2147/CEOR.S392566
37. Polak TB, Cucchi DGJ, Darrow JJ, Versteegh MM. Incremental benefits of novel pharmaceuticals in the UK: a cross-sectional analysis of NICE technology appraisals from 2010 to 2020. BMJ Open. 2022;12(4):e058279. doi: 10.1136/bmjopen-2021-058279
38. Wisløff T, Hagen G, Hamidi V, Movik E, Klemp M, Olsen JA. Estimating QALY gains in applied studies: a review of cost-utility analyses published in 2010. Pharmacoeconomics. 2014;32:367–75. doi: 10.1007/s40273-014-0136-z
39. HAS-Sante. SAPIEN 3 treatment of severe symptomatic aortic stenosis in low-risk surgical patients in France. 2021. Available from: https://www.has-sante.fr/upload/docs/application/pdf/2021-04/sapien3_9022021_avis_economique_vf2.pdf [cited September 2023].
40. Norwegian Institute of Public Health (NIPH). Transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis and low surgical risk and across surgical risk groups: a health technology assessment. 2021. Available from: https://www.fhi.no/en/publ/2021/TAVI-vs-SAVR-for-patients-with-severe-aortic-stenosis-and-low-surgical-risk-and-across-surgical-risk-groups/ [cited September 2023].
41. Health Information and Quality Authority (HIQA). Health technology assessment of transcatheter aortic valve implantation (TAVI) in patients with severe symptomatic aortic stenosis at low and intermediate risk of surgical complications. 2019. Available from: https://www.hiqa.ie/sites/default/files/2019-12/TAVI_HTA.pdf [cited September 2023].
42. Zhou JY, Liew D, Duffy SJ, Walton A, Htun N, Stub D. Cost-effectiveness of transcatheter versus surgical aortic valve replacement in low-risk patients with severe aortic stenosis. Heart Lung Circ. 2021;30:547–54. doi: 10.1016/j.hlc.2020.09.934
43. Tam DY, Azizi PM, Fremes SE, Chikwe J, Gaudino M, Wijeysundera HC. The cost-effectiveness of transcatheter aortic valve replacement in low surgical risk patients with severe aortic stenosis. Eur Heart J Qual Care Clin Outcomes. 2021;7:556–63. doi: 10.1093/ehjqcco/qcaa058
44. Lytvyn L, Guyatt GH, Manja V, Siemieniuk RA, Zhang Y, Agoritsas T, et al. Patient values and preferences on transcatheter or surgical aortic valve replacement therapy for aortic stenosis: a systematic review. BMJ Open. 2016;6:e014327. doi: 10.1136/bmjopen-2016-014327
45. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450. doi: 10.1186/1471-2458-11-450
46. Kostnad per patient (KPP). Available from: https://skr.se/skr/halsasjukvard/ekonomiavgifter/kostnadperpatientkpp.1076.html [cited April 2024].
Published
2024-11-11
How to Cite
Nilsson K., James S., Angerås O., Backes J., Bjursten H., Candolfi P., Götberg M., Hagström H., Malmberg C., Nielsen N. E., Sarmah A., Settergren M., & Bromilow T. (2024). Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden. Upsala Journal of Medical Sciences, 129, e10741. https://doi.org/10.48101/ujms.v129.10741
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Original Articles
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