The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement
Tóm tắt
The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. This is a cost-utility analysis from the perspective of the Spanish National Health Service. Results of two prospective hospital registries (158 and 273 consecutive patients) were incorporated into a probabilistic Markov model to compare quality adjusted life years (QALYs) and costs for TAVR after waiting for 3–12 months, relative to immediate TAVR. We simulated a cohort of 1000 patients, male, and 80 years old; other patient profiles were assessed in sensitivity analyses. As waiting time increased, costs decreased at the expense of lower survival and loss of QALYs, leading to incremental cost-effectiveness ratios for eliminating waiting lists of about 12,500 € per QALY. In subgroup analyses prioritization of patients for whom higher benefit was expected led to a smaller loss of QALYs. Concerning budget impact, long waiting lists reduced spending considerably and permanently. A shorter waiting time is likely to be cost-effective (considering commonly accepted willingness-to-pay thresholds in Europe) relative to 3 months or longer waiting periods. If waiting lists are nevertheless seen as unavoidable due to severe but temporary budgetary restrictions, prioritizing patients for whom higher benefit is expected appears to be a way of postponing spending without utterly sacrificing patients’ survival and quality of life.
Tài liệu tham khảo
Morgan, D., Astoli, R.: Health spending growth at zero: whichcountries, which sectors are most affected?, OECD Health Working Papers, No. 60, OECD Publishing, Paris (2013). http://dx.doi.org/10.1787/5k4dd1st95xv-en
Siciliani, L., Moran, V., Michael, Borowitz: Measuring and comparing health care waiting times in OECD countries. Health Policy (New York) 118, 292–303 (2014)
Departament de Salut: CatSalut. Servei Català de la Salut. http://catsalut.gencat.cat/ca/ciutadania/serveis-atencio-salut/com-accedeix/llistes-espera/operacions-quirurgiques/consulta/. Accessed 21 Nov 2017
Eveborn, G.W., Schirmer, H., Heggelund, G., Lunde, P., Rasmussen, K.: The evolving epidemiology of valvular aortic stenosis. The Tromsø Study. Heart 99, 396–400 (2013)
Lindroos, M., Kupari, M., Heikkilä, J., Tilvis, R.: Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J. Am. Coll. Cardiol. 21, 1220–1225 (1993)
Nkomo, V.T., Gardin, J.M., Skelton, T.N., Gottdiener, J.S., Scott, C.G., Enriquez-Sarano, M.: Burden of valvular heart diseases: a population-based study. Lancet 368, 1005–1011 (2006)
Ferreira-González, I., Pinar-Sopena, J., Ribera, A., Marsal, J.R., Cascant, P., González-Alujas, T., Evangelista, A., Brotons, C., Moral, I., Permanyer-Miralda, G., García-Dorado, D., Tornos, P.: Prevalence of calcific aortic valve disease in the elderly and associated risk factors: a population-based study in a Mediterranean area. Eur. J. Prev. Cardiol. 20, 1022–1030 (2013)
Rosenhek, R., Zilberszac, R., Schemper, M., Czerny, M., Mundigler, G., Graf, S., Bergler-Klein, J., Grimm, M., Gabriel, H., Maurer, G.: Natural history of very severe aortic stenosis. Circulation 121, 151–156 (2010)
Ribera, A., Slof, J., Andrea, R., Falces, C., Gutiérrez, E., Del Valle-Fernández, R., Morís-De La Tassa, C., Mota, P., Oteo, J.F., Cascant, P., Altisent, O.A.J., Sureda, C., Serra, V., García-Del Blanco, B., Tornos, P., Garcia-Dorado, D., Ferreira-González, I.: Transfemoral transcatheter aortic valve replacement compared with surgical replacement in patients with severe aortic stenosis and comparable risk: cost-utility and its determinants. Int. J. Cardiol. 182, 321–328 (2015)
Indraratna, P., Ang, S.C., Gada, H., Yan, T.D., Manganas, C., Bannon, P., Cao, C.: Systematic review of the cost-effectiveness of transcatheter aortic valve implantation. J. Thorac. Cardiovasc. Surg. 148, 509–514 (2014)
Mylotte, D., Osnabrugge, R.L.J., Windecker, S., Lefèvre, T., de Jaegere, P., Jeger, R., Wenaweser, P., Maisano, F., Moat, N., Søndergaard, L., Bosmans, J., Teles, R.C., Martucci, G., Manoharan, G., Garcia, E., Van Mieghem, N.M., Kappetein, A.P., Serruys, P.W., Lange, R., Piazza, N.: Transcatheter aortic valve replacement in Europe: adoption trends and factors influencing device utilization. J. Am. Coll. Cardiol. 62, 210–219 (2013)
Jiménez-Quevedo, P., Serrador, A., Pérez de Prado, A., Pan, M.: Registro Español de Hemodinámica y Cardiología Intervencionista. XXV Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990–2015). Rev. Española Cardiol. 69, 1180–1189 (2016)
Salinas, P., Moreno, R., Calvo, L., Sánchez-Recalde, Á., Jiménez-Valero, S., Galeote, G., López-Fernández, T., Ramírez, U., Riera, L., Plaza, I., Moreno, I., Mesa, J.M., López-Sendón, J.L.: Long-term follow-up after transcatheter aortic valve implantation for severe aortic stenosis. Rev. Española Cardiol. 69, 37–44 (2016)
Avanzas, P., Pascual, I., Muñoz-García, A.J., Segura, J., Alonso-Briales, J.H., Suárez de Lezo, J., Pan, M., Jiménez-Navarro, M.F., López-Aguilera, J., Hernández-García, J.M., Morís, C.: Long-term follow-up of patients with severe aortic stenosis treated with a self-expanding prosthesis. Rev. Española Cardiol. 70, 247–253 (2016)
Osnabrugge, R.L.J., Mylotte, D., Head, S.J., Van Mieghem, N.M., Nkomo, V.T., Lereun, C.M., Bogers, A.J.J.C., Piazza, N., Kappetein, P.: Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J. Am. Coll. Cardiol. 62, 1002–1012 (2013)
Baumgartner, H., Falk, V., Bax, J.J., De Bonis, M., Hamm, C., Holm, P.J., Iung, B., Lancellotti, P., Lansac, E., Muñoz, D.R., Rosenhek, R., Sjögren, J., Tornos Mas, P., Vahanian, A., Walther, T., Wendler, O., Windecker, S., Zamorano, J.L.: 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur. Heart J. 38, 2739–2791 (2017)
Leon, M.B., Smith, C.R., Mack, M.J., Makkar, R.R., Svensson, L.G., Kodali, S.K., Thourani, V.H., Tuzcu, E.M., Miller, D.C., Herrmann, H.C., Doshi, D., Cohen, D.J., Pichard, A.D., Kapadia, S., Dewey, T., Babaliaros, V., Szeto, W.Y., Williams, M.R., Kereiakes, D., Zajarias, A., Greason, K.L., Whisenant, B.K., Hodson, R.W., Moses, J.W., Trento, A., Brown, D.L., Fearon, W.F., Pibarot, P., Hahn, R.T., Jaber, W.A., Anderson, W.N., Alu, M.C., Webb, J.G.: PARTNER 2 investigators: transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N. Engl. J. Med. 374, 1609–1620 (2016)
Reardon, M.J., Van Mieghem, N.M., Popma, J.J., Kleiman, N.S., Søndergaard, L., Mumtaz, M., Adams, D.H., Deeb, G.M., Maini, B., Gada, H., Chetcuti, S., Gleason, T., Heiser, J., Lange, R., Merhi, W., Oh, J.K., Olsen, P.S., Piazza, N., Williams, M., Windecker, S., Yakubov, S.J., Grube, E., Makkar, R., Lee, J.S., Conte, J., Vang, E., Nguyen, H., Chang, Y., Mugglin, A.S., Serruys, P.W.J.C., Kappetein, A.P.: SURTAVI investigators: surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N. Engl. J. Med. 376, 1321–1331 (2017)
Vahanian, A., Alfieri, O., Andreotti, F., Antunes, M.J., Barón-Esquivias, G., Baumgartner, H., Borger, M.A., Carrel, T.P., De Bonis, M., Evangelista, A., Falk, V., Lung, B., Lancellotti, P., Pierard, L., Price, S., Schäfers, H.-J., Schuler, G., Stepinska, J., Swedberg, K., Takkenberg, J., Von Oppell, U.O., Windecker, S., Zamorano, J.L., Zembala, M.: Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur. J. Cardiothorac. Surg. 42, S1–S44 (2012)
Ramos-Goni, J.M., Rivero-Arias, O.: eq5d: a command to calculate index values for the EQ-5D quality-of-life instrument. Stata J. 11, 120–125 (2011)
Ministerio de Sanidad, Servicios Sociales e Igualdad. Instituto Nacional de Estadística. Encuesta Nacional de Salud. España 2011/12. Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, 2013. http://www.msssi.gob.es/estadEstudios/estadisticas/sisInfSanSNS/nivelSalud.htm. Accessed 21 Nov 2017
Briggs, A., Sculpher, M.: An introduction to Markov modelling for economic evaluation. Pharmacoeconomics 13, 397–409 (1998)
Siciliani, L., Stanciole, A., Jacobs, R.: Do waiting times reduce hospital costs? J. Health Econ. 28, 771–780 (2009)
Kahneman, D., Tversky, A.: Prospect theory: an analysis of decision under risk. Econometrica 47, 263–291 (1979)
Vallejo-Torres, L., García-Lorenzo, B., Castilla, I., Valcárcel Nazco, C., García-Pérez, L., Linertová, R., Serrano-Aguilar, P.: Valor Monetario de un AVAC: Estimación empírica del coste de oportunidad en el Sistema Nacional de Salud, Ministerio de Sanidad, Servicios Sociales e Igualdad. Servicio de Evaluación del Servicio Canario de la Salud; 2015. Informes de Evaluación de Tecnologías Sanitarias. http://www3.gobiernodecanarias.org/sanidad/scs/contenidoGenerico.jsp?idDocument=e690e0c1-cbed-11e5-a9c5-a398589805dc&idCarpeta=993a9b1d-7aed-11e4-a62a-758e414b4260. Accessed 21 Nov 2017
Henriksson, M., Palmer, S., Chen, R., Damant, J., Fitzpatrick, N.K., Abrams, K., Hingorani, A.D., Stenestrand, U., Janzon, M., Feder, G., Keogh, B., Shipley, M.J., Kaski, J.-C., Timmis, A., Sculpher, M., Hemingway, H.: Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery. BMJ 340, b5606 (2010)
Watt, M., Mealing, S., Eaton, J., Piazza, N., Moat, N., Brasseur, P., Palmer, S., Busca, R., Sculpher, M.: Cost-effectiveness of transcatheter aortic valve replacement in patients ineligible for conventional aortic valve replacement. Heart 98, 370–376 (2012)
Jahn, B., Pfeiffer, K.P., Theurl, E., Tarride, J.E., Goeree, R.: Capacity constraints and cost-effectiveness: a discrete event simulation for drug-eluting stents. Med. Decis. Making 30, 16–28 (2010)
Comas, M., Castells, X., Hoffmeister, L., Román, R., Cots, F., Mar, J., Gutiérrez-Moreno, S., Espallargues, M.: Discrete-event simulation applied to analysis of waiting lists. Evaluation of a prioritization system for cataract surgery. Value Health 11, 1203–1213 (2008)
Koopmanschap, M., Brouwer, W.B.F., Hakkaart-Van Roijen, L., Van Exel, N.J.: Influence of waiting time on cost-effectiveness. Soc. Sci. Med. 60, 2501–2504 (2005)
Tuominen, U., Sintonen, H., Hirvonen, J., Seitsalo, S., Paavolainen, P., Lehto, M., Hietaniemi, K., Blom, M.: Is longer waiting time for total knee replacement associated with health outcomes and medication costs? Randomized clinical trial. Value Health 13, 998–1004 (2010)
Tuominen, U., Sintonen, H., Aronen, P., Hirvonen, J., Seitsalo, S., Lehto, M., Hietaniemi, K., Blom, M.: Cost-utility of waiting time in total joint replacements: a randomized clinical trial. Int. J. Technol. Assess. Health Care 29, 27–34 (2013)
Chauvin, P., Josselin, J.-M., Heresbach, D.: The influence of waiting times on cost-effectiveness: a case study of colorectal cancer mass screening. Eur. J. Health Econ. 15, 801–812 (2014)