John K. Peel
Financial Incentives for Transcatheter Aortic Valve Implantation in Ontario, Canada: A Cost-Utility Analysis
Peel, John K.; Miranda, Rafael Neves; Naimark, David; Woodward, Graham; Mamas, Mamas A.; Madan, Mina; Wijeysundera, Harindra C.
Authors
Rafael Neves Miranda
David Naimark
Graham Woodward
Mamas Mamas m.mamas@keele.ac.uk
Mina Madan
Harindra C. Wijeysundera
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for patients with severe aortic stenosis, which has become standard of care. The objective of this study was to determine the maximum cost-effective investment in TAVI care that should be made at a health system level to meet quality indicator goals. Methods and Results We performed a cost-utility analysis using probabilistic patient-level simulation of TAVI care from the Ontario, Canada, Ministry of Health perspective. Costs and health utilities were accrued over a 2-year time horizon. We created 4 hypothetical strategies that represented TAVI care meeting =1 quality indicator targets, (1) reduced wait times, (2) reduced hospital length of stay, (3) reduced pacemaker use, and (4) combined strategy, and compared these with current TAVI care. Per-person costs, quality-adjusted life years, and clinical outcomes were estimated by the model. Using these, incremental net monetary benefits were calculated for each strategy at different cost-effectiveness thresholds between $0 and $100 000 per quality-adjusted life year. Clinical improvements over the current practice were estimated with all comparator strategies. In Ontario, achieving quality indicator benchmarks could avoid ˜26 wait-list deaths and 200 wait-list hospitalizations annually. Compared with current TAVI care, the incremental net monetary benefit for this strategy varied from $10 765 (±$8721) and $17 221 (±$8977). This would translate to an annual investment of between ˜$14 to ˜$22 million by the Ontario Ministry of Health to incentivize these performance measures being cost-effective. Conclusions This study has quantified the modest annual investment required and substantial clinical benefit of meeting improvement goals in TAVI care.
Journal Article Type | Article |
---|---|
Acceptance Date | Mar 9, 2022 |
Online Publication Date | Apr 12, 2022 |
Publication Date | Apr 19, 2022 |
Publicly Available Date | May 30, 2023 |
Journal | Journal of the American Heart Association |
Publisher | Wiley Open Access |
Volume | 11 |
Issue | 8 |
Article Number | ARTN e025085 |
DOI | https://doi.org/10.1161/jaha.121.025085 |
Keywords | quality improvement, transcatheter aortic valve replacement, health care costs, quality indicators |
Publisher URL | https://doi.org/10.1161/JAHA.121.025085 |
Files
JAHA.121.025085.pdf
(924 Kb)
PDF
Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/
You might also like
Downloadable Citations
About Keele Repository
Administrator e-mail: research.openaccess@keele.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2024
Advanced Search