Cost-effectiveness of transcatheter aortic valve implantation in older patients with aortic stenosis: a large-scale retrospective cohort study using an administrative claims database.

Effects of transcatheter aortic valve implantation (TAVI) on cost-effectiveness in older patients with aortic stenosis (AS) compared with medical therapy (MT) were not well scrutinized in the real-world settings. Patients with AS were extracted from an administrative claims database of late elderly patients aged ≥ 75 years in Japan from 2018 to 2021. The patients were divided into TAVI and MT groups, and all-cause death and medical costs were compared between the two groups. The effect of TAVI on mortality compared with MT and the incremental cost-effectiveness ratio (ICER) of the TAVI compared with MT were calculated in JPY/quality-adjusted life year (QALY). Of the 45,664 patients analyzed, 2,217 (4.9%) were in the TAVI group. Three-year mortality was 12.5% in the TAVI group and 22.5% in the MT group (P < 0.0001). Median (IQR) costs were 9,275,870 (7,761,600-11,654,645) JPY for TAVI and 2,364,740 (1,097,930-4,925,940) JPY for MT (P < 0.0001). The adjusted hazard ratio (95% confidence interval) for all-cause death in the TAVI group relative to the MT group was 0.61 (0.53-0.68). The ICER of the TAVI group compared with the MT group was 11,485,734 JPY/QALY. TAVI improved mortality than MT for 3 years. From the perspective of 3-year period, its cost-effectiveness should be considered in patients aged 75 years or elder.