ArticleJournal of the Society for Cardiovascular Angiography & Interventions2026
Cost-Effectiveness of Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo-Surgical Aortic Valve Replacement for Degenerated Bioprosthetic Aortic Valve.
Article in Journal of the Society for Cardiovascular Angiography & Interventions, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
10 authors.
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Abstract
Background: Degenerated bioprosthetic aortic valves are associated with substantial morbidity, mortality, and health care resource use. Treatment options include redo-surgical aortic valve replacement (redo-SAVR) and valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). ViV-TAVR has been associated with shorter length of stay, but its higher device costs have raised uncertainty about its overall economic value. We constructed a decision-analytic model to compare the cost-effectiveness of ViV-TAVR vs redo-SAVR for the management of degenerated bioprosthetic aortic valves. Methods: Cost-effectiveness was evaluated by calculating deaths averted and incremental cost-effectiveness ratios (ICERs). The main outcome was ICER defined as US dollars/deaths averted. Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. Results: In the probabilistic analysis, the mean total cost of ViV-TAVR was $88,829 (95% CI, $88,554-$89,104) with a 2-month survival probability of 0.97 (95% CI, 0.969-0.970). For redo-SAVR, the mean cost was $91,411 (95% CI, $91,163-$91,659) with a 2-month survival probability of 0.96 (95% CI, 0.959-0.961). ViV-TAVR was the dominant strategy, resulting in a mean ICER of -$259,323 per death averted (95% CI, -$304,599 to -$220,679). ViV-TAVR was cost effective in 57% to 58% of simulations for willingness-to-pay thresholds ranging from $0 to $150,000. Conclusions: ViV-TAVR is an economically dominant strategy for the management of degenerated bioprosthetic aortic valves, yielding lower costs and marginally improved short-term survival relative to redo-SAVR. However, given a moderate degree of decisional uncertainty, trial-level comparative data and longer-term modeling are required to refine these estimates.
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