Model-based economic evaluation for medical decision making: learn from the past and prepare for the future

In July 2012 issue of Annals of Cardiothoracic Surgery, Gada and colleagues (1) presented an economic evaluation for transapical aortic valve implantation (TAVI) in high risk patients with aortic stenosis. A Markov model was developed to compare mortality, costs and quality-adjusted life years (QALYs) of TAVI with aortic valve replacement (AVR) and medical management from a payer’s perspective over a life time horizon. In the reference case, the incremental cost effectiveness ratios (ICERs) were $44,384/QALY for TAVI and $42,637/QALY for AVR when compared with the medical management, while TAVI was dominated by AVR (i.e. TAVI gained fewer QALYs at higher costs). The ICERs were sensitive to post-surgery mortality, health utilities, and the cost of TAVI.