A cost-utility analysis comparing transcatheter and surgical pulmonary valve replacement among Indonesia patients with a history of newborn right ventricular outflow tract correction

Abstract

Transcatheter pulmonary valve replacement (TPVR) was launched since 2000. It indicated for cardiac patients who have the right ventricular outflow tract obstruction (RVOT) and a prior surgery history. TPVR have a shorter hospital stay, fewer complications, and a less-invasive method. However, TPVR is more expensive than surgical pulmonary valve replacement (SPVR). This raises access concerns for low income countries. There are no cost-effectiveness studies in Indonesia, and limited efficiency evidence due to rare disorder. It is a challenge in building the appropriate access strategies. Therefore, this study aims to investigate the cost-utility, resulted in total costs, quality-adjusted life-years (QALYs), life-years (LYs) and incremental cost-effectiveness ratio (ICER). The analysis included costs associated with hospitalization, inpatients and outpatients, and complication costs.

A Markov simulation was modelled to estimate a hypothetical cohort of cardiac surgery experienced paediatric patients who require RVOT remodelling via either SPVR or TPVR during lifelong care. The methodology follows Indonesian health technology assessment guideline, and clinical inputs were derived from two meta-analyses and slightly modified by published articles. We include 3% discount rate of outcome and the consumer price index adjusted price in 2023. Sensitivity analyses were conducted both deterministically and probabilistically.

Total costs between TPVR and SPVR were 71,033.15 USD and 23,946.02 USD, while QALYs gained accounted for 14.23 and 11.77 QALYs, respectively. Shown by ICER at 19,191.37 USD/QALY against one GDP of 3,900 USD, TPVR revealed that it was not cost-effective. For deterministic sensitivity analysis (DSA), utility index of initial TPVR has considerably impact while a price of TPVR is a fourth factor to ICER’s. For probabilistic sensitivity analysis (PSA) confirm TPVR is more effective but more expensive. A 60-70% price reduction of TPVR will achieve the optimum price of TPVR provision.