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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.

Financial Incentives for Transcatheter Aortic Valve Implantation in Ontario, Canada: A Cost-Utility Analysis Thumbnail


Authors

John K. Peel

Rafael Neves Miranda

David Naimark

Graham Woodward

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 Mar 28, 2024
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