Systematic review of model-based economic evaluations of heart valve implantationsReportar como inadecuado

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The European Journal of Health Economics

pp 1–15

First Online: 06 March 2017Received: 01 July 2016Accepted: 16 February 2017DOI: 10.1007-s10198-017-0880-z

Cite this article as: Huygens, S.A., Takkenberg, J.J.M. & Rutten-van Mölken, M.P.M.H. Eur J Health Econ 2017. doi:10.1007-s10198-017-0880-z


ObjectiveTo review the evidence on the cost-effectiveness of heart valve implantations generated by decision analytic models and to assess their methodological quality.

MethodsA systematic review was performed including model-based cost-effectiveness analyses of heart valve implantations. Study and model characteristics and cost-effectiveness results were extracted and the methodological quality was assessed using the Philips checklist.

ResultsFourteen decision-analytic models regarding the cost-effectiveness of heart valve implantations were identified. In most studies transcatheter aortic valve implantation TAVI was cost-effective compared to standard treatment ST in inoperable or high-risk operable patients ICER range 18,421–120,779 € and in all studies surgical aortic valve replacement SAVR was cost-effective compared to ST in operable patients ICER range 14,108–40,944 €, but the results were not consistent on the cost-effectiveness of TAVI versus SAVR in high-risk operable patients ICER range: dominant to dominated by SAVR. Mechanical mitral valve replacement MVR had the lowest costs per success compared to mitral valve repair and biological MVR. The methodological quality of the studies was moderate to good.

ConclusionThis review showed that improvements can be made in the description and justification of methods and data sources, sensitivity analysis on extrapolation of results, subgroup analyses, consideration of methodological and structural uncertainty, and consistency i.e. validity of the models. There are several opportunities for future decision-analytic models of the cost-effectiveness of heart valve implantations: considering heart valve implantations in other valve positions besides the aortic valve, using a societal perspective, and developing patient-simulation models to investigate the impact of patient characteristics on outcomes.

KeywordsSystematic review Decision-analytic model Economic evaluation Heart valve implantations Electronic supplementary materialThe online version of this article doi:10.1007-s10198-017-0880-z contains supplementary material, which is available to authorized users.

JEL ClassificationI190  Download fulltext PDF

Autor: Simone A. Huygens - Johanna. J. M. Takkenberg - Maureen P. M. H. Rutten-van Mölken


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