Management of heart disease is a major focus in health care today. Treatment modalities for the various complications that occur because of heart disease are some of the more costly treatments in all of health care. One specific procedure, transcatheter aortic valve replacement (TAVR), is an effective option for CAD patients needing valve replacement and who are often too high of a surgical risk for traditional or standard surgery. According to Faroux et al., (2019), about one half of TAVR candidates have coronary artery disease (CAD). However, TAVRs are being performed in inconsistent facilities with varying levels of experience (Faroux et al, 2019). Because of this, it is essential that healthcare providers have a better understanding of the quality-of-life and cost-effectiveness of TAVRs as compared to other treatment modalities. Gialama et al., (2018), explain that valvular heart disease (VHD) is estimated to be at 2.5% currently in industrialized countries; and is markedly increased after 65 years of age. Therefore, the prevalence, and proposed treatments, need further exploration to ensure the most appropriate treatments is provided in the most cost-effective manner.
To determine cost-effectiveness, a systematic review by Gialama et al., (2018) summarized 24 studies published between 2012 and 2017, which focused on the economic evaluation of transcatheter aortic valve implementation and transcatheter mitral valve repair versus standard surgical procedures. Although the conclusion of this review indicates there is cost-effectiveness, the limitations of this study, and need for further research make the outcomes questionable (Gialama et al., 2018).
- Does the research design answer the research question? Explain your rationale.
The short answer is yes; however, more research is needed. Another point to consider is not only the cost-effectiveness of the procedures themselves, but the long-term impact. Will patients need more healthcare, or less? Determining cost-effectiveness needs to include more than just the costs of the procedures and associated costs; but the costs of needed care “down the road”. If the procedure is a “one and done” then, it is clearer, but if the procedure is only a band-aid for now, then is it really cost-effective? Additionally, limitations of the review, discussed below, continue to support the question of valid proof of cost effectiveness (Gialama et al., 2018).
- Were the study sample participants representative? Why or why not?
No. The studies included in this review were limited (further discussed below). The criteria for this review was very specific; but may have omitted studies done in other areas, and published in other languages, which may have provided much-needed enhanced information. Exclusions included: studies in other languages, abstracts, editorials, letters, case reports, conference presentations, expert opinions, reviews, all of which could provide more data to substantiate the cost-effectiveness, or not (Gialama et al., 2018).
- Compare and contrast the study limitations in this study.
Limitations in this review are primarily related to the exclusions. The review included 24 studies, all in the English language, and many needing further research. Based upon this information, the limitations of the study are largely excluding patient data which would be helpful in fully determining the cost-effectiveness for both the short-term and long-term effect.
- Based on this evidence summary, would you consider this systematic review as support for your selected practice problem? Explain your rationale.
This systematic review provides a foundation for understanding of the cost-effectiveness of the TAV procedures, however, until more is known about studies conducted in more diverse settings, and a more streamlined process for evaluation in comparable institutions and experience, the results from this review are not conclusive enough to make a definitive determination of the overall cost-effectiveness of this treatment modality.
Faroux, L., Guimaraes, L., Wintzer-Wehekind, J., Junquera, L., Ferreira-Neto, A. N., Del Val, D., Muntané-Carol, G., Mohammadi, S., Paradis, J. M., & Rodés-Cabau, J. (2019). Coronary artery disease and transcatheter aortic valve replacement, Journal of the American College of Cardiology, 74(3), 362-372. doi: 10.1016/j.jacc.2019.06.012. PMID: 31319919.
Gialama, F., Prezerakos, P., Apostolopoulos, V., & Maniadakis, N. (2018). Systematic review of the cost-effectiveness of transcatheter interventions for valvular heart disease. European Heart Journal, 4(2), 81-90. DOI:10.1093/ehjqcco/qcx049