Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions
Background: Aortic stenosis is a prevalent valvular heart disease that is treated primarily by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), which are common treatments for addressing symptoms secondary to valvular heart disease. This narrative review art...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-10-01
|
| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906721001524 |
| _version_ | 1819022344924954624 |
|---|---|
| author | Maximilian A. Fliegner Devraj Sukul Michael P. Thompson Nirav J. Shah Reza Soroushmehr Jeffrey S. McCullough Donald S. Likosky |
| author_facet | Maximilian A. Fliegner Devraj Sukul Michael P. Thompson Nirav J. Shah Reza Soroushmehr Jeffrey S. McCullough Donald S. Likosky |
| author_sort | Maximilian A. Fliegner |
| collection | DOAJ |
| description | Background: Aortic stenosis is a prevalent valvular heart disease that is treated primarily by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), which are common treatments for addressing symptoms secondary to valvular heart disease. This narrative review article focuses on the existing literature comparing recovery and cost-effectiveness for SAVR and TAVR. Methods: Major databases were searched for relevant literature discussing HRQOL and cost-effectiveness of TAVR and SAVR. We also searched for studies analyzing the use of wearable devices to monitor post-discharge recovery patterns. Results: The literature focusing on quality-of-life following TAVR and SAVR has been limited primarily to single-center observational studies and randomized controlled trials. Studies focused on TAVR report consistent and rapid improvement relative to baseline status. Common HRQOL instruments (SF-36, EQ-5D, KCCQ, MLHFQ) have been used to document that TF-TAVR is advantageous over SAVR at 1-month follow-up, with the benefits leveling off following 1 year. TF-TAVR is economically favorable relative to SAVR, with estimated incremental cost-effectiveness ratio values ranging from $50,000 to $63,000/QALY gained. TA-TAVR has not been reported to be advantageous from an HRQOL or cost-effectiveness perspective. Conclusions: While real-world experiences are less described, large-scale trials have advanced our understanding of recovery and cost-effectiveness of aortic valve replacement treatment strategies. Future work should focus on scalable wearable device technology, such as smartwatches and heart-rate monitors, to facilitate real-world evaluation of TAVR and SAVR to support clinical decision-making and outcomes ascertainment. |
| first_indexed | 2024-12-21T04:21:31Z |
| format | Article |
| id | doaj.art-e45cbe894e3c48aa926a7b60c490c59d |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-21T04:21:31Z |
| publishDate | 2021-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-e45cbe894e3c48aa926a7b60c490c59d2022-12-21T19:16:09ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672021-10-0136100864Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directionsMaximilian A. Fliegner0Devraj Sukul1Michael P. Thompson2Nirav J. Shah3Reza Soroushmehr4Jeffrey S. McCullough5Donald S. Likosky6Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United StatesDivision of Cardiovascular Medicine, Department of General Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United StatesDepartment of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United StatesDepartment of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United StatesDepartment of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United StatesDepartment of Health Management and Policy, School of Public Health, University of Michigan., Ann Arbor, MI, United StatesDepartment of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States; Corresponding author at: 1500 E Medical Center Drive, 5144 Frankel Cardiovascular Center, Ann Arbor, MI 48109, United States.Background: Aortic stenosis is a prevalent valvular heart disease that is treated primarily by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), which are common treatments for addressing symptoms secondary to valvular heart disease. This narrative review article focuses on the existing literature comparing recovery and cost-effectiveness for SAVR and TAVR. Methods: Major databases were searched for relevant literature discussing HRQOL and cost-effectiveness of TAVR and SAVR. We also searched for studies analyzing the use of wearable devices to monitor post-discharge recovery patterns. Results: The literature focusing on quality-of-life following TAVR and SAVR has been limited primarily to single-center observational studies and randomized controlled trials. Studies focused on TAVR report consistent and rapid improvement relative to baseline status. Common HRQOL instruments (SF-36, EQ-5D, KCCQ, MLHFQ) have been used to document that TF-TAVR is advantageous over SAVR at 1-month follow-up, with the benefits leveling off following 1 year. TF-TAVR is economically favorable relative to SAVR, with estimated incremental cost-effectiveness ratio values ranging from $50,000 to $63,000/QALY gained. TA-TAVR has not been reported to be advantageous from an HRQOL or cost-effectiveness perspective. Conclusions: While real-world experiences are less described, large-scale trials have advanced our understanding of recovery and cost-effectiveness of aortic valve replacement treatment strategies. Future work should focus on scalable wearable device technology, such as smartwatches and heart-rate monitors, to facilitate real-world evaluation of TAVR and SAVR to support clinical decision-making and outcomes ascertainment.http://www.sciencedirect.com/science/article/pii/S2352906721001524TAVRSAVRAortic StenosisValvular heart diseaseWearable Devices |
| spellingShingle | Maximilian A. Fliegner Devraj Sukul Michael P. Thompson Nirav J. Shah Reza Soroushmehr Jeffrey S. McCullough Donald S. Likosky Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions International Journal of Cardiology: Heart & Vasculature TAVR SAVR Aortic Stenosis Valvular heart disease Wearable Devices |
| title | Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions |
| title_full | Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions |
| title_fullStr | Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions |
| title_full_unstemmed | Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions |
| title_short | Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions |
| title_sort | evaluating treatment specific post discharge quality of life and cost effectiveness of tavr and savr current practice amp future directions |
| topic | TAVR SAVR Aortic Stenosis Valvular heart disease Wearable Devices |
| url | http://www.sciencedirect.com/science/article/pii/S2352906721001524 |
| work_keys_str_mv | AT maximilianafliegner evaluatingtreatmentspecificpostdischargequalityoflifeandcosteffectivenessoftavrandsavrcurrentpracticeampfuturedirections AT devrajsukul evaluatingtreatmentspecificpostdischargequalityoflifeandcosteffectivenessoftavrandsavrcurrentpracticeampfuturedirections AT michaelpthompson evaluatingtreatmentspecificpostdischargequalityoflifeandcosteffectivenessoftavrandsavrcurrentpracticeampfuturedirections AT niravjshah evaluatingtreatmentspecificpostdischargequalityoflifeandcosteffectivenessoftavrandsavrcurrentpracticeampfuturedirections AT rezasoroushmehr evaluatingtreatmentspecificpostdischargequalityoflifeandcosteffectivenessoftavrandsavrcurrentpracticeampfuturedirections AT jeffreysmccullough evaluatingtreatmentspecificpostdischargequalityoflifeandcosteffectivenessoftavrandsavrcurrentpracticeampfuturedirections AT donaldslikosky evaluatingtreatmentspecificpostdischargequalityoflifeandcosteffectivenessoftavrandsavrcurrentpracticeampfuturedirections |