Cost-effectiveness of aortic valve replacement in the elderly: An introductory study

Mean age of patients who underwent AVR by surgery year. AVR, aortic valve replacement.

Number of patients who underwent AVR by age at surgery. AVR, aortic valve replacement.

Survival of patients with severe, unoperated aortic valve disease from the literature (the thin light gray curves are series from literature, and the thick light gray curve is the weighted average) and survival of 4617 patients after AVR from the authors’ series (thick black curve).

A, Observed survival after AVR (black curve in Figure 3) by follow-up NYHA class. The areas of the different shadings are proportional to the patients’ NYHA status during the follow-up years. For example, the majority of patients lived with NYHA class I or II during their remaining lifetime (big areas of light gray colors). B, Estimated survival (thick gray line in Figure 3) by follow-up NYHA class as if patients in (A) did not undergo operation. The majority of patients would have lived with NYHA class IV during their remaining lifetime (big area of black color). AVR, Aortic valve replacement; NYHA, New York Heart Association.

A, Total life years (light gray bars) and respective QALYs (dark gray bars) after AVR by age at surgery. This shows approximately 75% diminution from perfect health across all age groups after AVR. B, Total life years (light gray bars) and respective QALYs (dark gray bars that are superimposed on the light gray bars) for natural history by age at surgery. This shows approximately 60% diminution from perfect health across all age groups. AVR, Aortic valve replacement; QALY, quality-adjusted life year.

A, Total QALYs gained after AVR by age at surgery. The height of each bar equals the difference of height of the dark gray bars in Figure 5, A and B. B, Mean QALYs gained after AVR by age at surgery (total QALYs gained in Figure 5, A divided by total number of patients in Figure 2 at each age group). AVR, aortic valve replacement; QALY, Quality-adjusted life year.

A, Total lifetime costs of AVR by age at surgery. B, Mean lifetime costs of AVR by age at surgery (total cost in Figure 7, A divided by total number of patients in Figure 2 at each age group). The mean cost was further broken down into cost of (1) original implantation; (2) ongoing maintenance (physician visit, echocardiogram, and anticoagulation treatment); and (3) treatment of prosthesis valve-related events (thromboembolism, bleeding, endocarditis, perivalvular leak, valve thrombosis, and reoperation). AVR, aortic valve replacement.

Average CER (cost per QALY) by age at surgery. Error bars indicate 95% ranges from 100× simulation. CER less than $20,000/QALY was judged as very cost-effective, between $20,000/QALY to $100,000/QALY as acceptable, and more than $100,000 as not cost-effective. The CERs were less than $20,000/QALY for most of the age groups. It was higher for older patients (>80 years), but still less than $100,000/QALY. CER, Cost-effectiveness ratio; QALY, quality-adjusted life year.