Present and future economic impact of transcatheter aortic valve replacement on the Portuguese national healthcare system
Introduction: Transcatheter aortic valve replacement (TAVR) has changed the treatment paradigm of severe aortic stenosis (AS). Nevertheless, in Portugal the penetration rate of TAVR is still very low and there is a paucity of data regarding its economic impact on the Portuguese healthcare system. Ai...
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Elsevier
2020-09-01
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Series: | Revista Portuguesa de Cardiologia (English Edition) |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S2174204920303172 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ricardo Fontes-Carvalho Cláudio Guerreiro Eduardo Infante Oliveira Pedro Braga |
spellingShingle |
Ricardo Fontes-Carvalho Cláudio Guerreiro Eduardo Infante Oliveira Pedro Braga Present and future economic impact of transcatheter aortic valve replacement on the Portuguese national healthcare system Revista Portuguesa de Cardiologia (English Edition) Estenose aórtica Válvula aórtica percutânea (VAP) Análise económica Serviço Nacional de Saúde |
author_facet |
Ricardo Fontes-Carvalho Cláudio Guerreiro Eduardo Infante Oliveira Pedro Braga |
author_sort |
Ricardo Fontes-Carvalho |
title |
Present and future economic impact of transcatheter aortic valve replacement on the Portuguese national healthcare system |
title_short |
Present and future economic impact of transcatheter aortic valve replacement on the Portuguese national healthcare system |
title_full |
Present and future economic impact of transcatheter aortic valve replacement on the Portuguese national healthcare system |
title_fullStr |
Present and future economic impact of transcatheter aortic valve replacement on the Portuguese national healthcare system |
title_full_unstemmed |
Present and future economic impact of transcatheter aortic valve replacement on the Portuguese national healthcare system |
title_sort |
present and future economic impact of transcatheter aortic valve replacement on the portuguese national healthcare system |
publisher |
Elsevier |
series |
Revista Portuguesa de Cardiologia (English Edition) |
issn |
2174-2049 |
publishDate |
2020-09-01 |
description |
Introduction: Transcatheter aortic valve replacement (TAVR) has changed the treatment paradigm of severe aortic stenosis (AS). Nevertheless, in Portugal the penetration rate of TAVR is still very low and there is a paucity of data regarding its economic impact on the Portuguese healthcare system. Aims: To perform an economic analysis of the present and future impact of TAVR in Portugal and to propose health policy recommendations for a new reimbursement model. Methods: Hospital data from a high-volume center were used as a sample to calculate the costs of TAVR in Portugal. Information regarding the national penetration rate was derived from the EAPCI Valve for Life initiative. To estimate the future demand for TAVR, three scenarios (S) were constructed: S1, TAVR penetration according to current guidelines; S2, including intermediate-risk patients; and S3, including low-risk patients aged over 75 years. Results: The total cost of each TAVR procedure in Portugal was 22 134.50 euros for the self-expanding valve (SEV) and 23 321.50 euros for the balloon-expanding valves (BEV). Most of the cost was driven by the price of the valve (SEV 74.5% vs. BEV 81.5%). The current national economic impact is estimated at 12 500 000 euros per year. In S1, the expected penetration rate would be 189 procedures per million population; in S2 we estimated an increase of 28% to 241 procedures per million population and in S3 an increase of 107% to 391 procedures per million population. The total economic impact would increase to 43 770 586 euros in S1 and to 90 754 310 euros in S3. Conclusions: TAVR is associated with a significant present and future economic impact on the Portuguese healthcare system. A new model of reimbursement in Portugal should be discussed and implemented. Resumo: Introdução: A válvula aórtica percutânea (VAP) mudou o paradigma de tratamento da estenose aórtica grave. No entanto, em Portugal, a sua penetração é reduzida e dados acerca do impacto económico no Serviço Nacional de Saúde (SNS) são escassos. Objetivos: Analisar o impacto económico atual e futuro do implante de VAP em Portugal e propor um modelo de reembolso específico para as VAP. Métodos: Os custos fixos e variáveis do procedimento em Portugal foram calculados com base numa amostra de um centro de elevado volume de VAP. O impacto económico nacional foi calculado com base na penetração atual reportada na iniciativa EAPCI Valve for Life. As necessidades futuras da tecnologia foram estimadas em três cenários (S): S1 - penetração de acordo com as recomendações atuais; S2 - inclusão de doentes de risco intermédio; S3 - expansão aos doentes de baixo risco e idade > 75 anos. Resultados: O custo total da VAP em Portugal foi estimado em 22.134,5€ com prótese autoexpansível (SEV) e 23.321,5€ com prótese expansível por balão (BEV). A maior parte do custo relacionou-se com o preço da prótese (SEV 74,5% versus BEV 81,5%). O impacto económico nacional estima-se em 12.500.000€/ano. No cenário S1, a taxa esperada de penetração deveria ser 189/milhão; em S2 perspetiva-se aumento de +28% para 241 procedimentos/milhão; em S3 estima-se aumento de +107% para 391 procedimentos/milhão. Assim, o impacto económico poderá aumentar significativamente de 43.770.586€ (S1) até 90.754.310€ (S3). Conclusões: A VAP está associada a um impacto económico presente e futuro significativo no SNS. É essencial discutir e implantar um novo modelo específico de reembolso em Portugal. |
topic |
Estenose aórtica Válvula aórtica percutânea (VAP) Análise económica Serviço Nacional de Saúde |
url |
http://www.sciencedirect.com/science/article/pii/S2174204920303172 |
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doaj-d3a5c53c9adc4e4c9257d6cd3a41722d2020-12-21T04:42:02ZengElsevierRevista Portuguesa de Cardiologia (English Edition)2174-20492020-09-01399479488Present and future economic impact of transcatheter aortic valve replacement on the Portuguese national healthcare systemRicardo Fontes-Carvalho0Cláudio Guerreiro1Eduardo Infante Oliveira2Pedro Braga3Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal; Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, Universidade do Porto, Porto, Portugal; Corresponding author.Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalDepartment of Cardiology, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, PortugalDepartment of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalIntroduction: Transcatheter aortic valve replacement (TAVR) has changed the treatment paradigm of severe aortic stenosis (AS). Nevertheless, in Portugal the penetration rate of TAVR is still very low and there is a paucity of data regarding its economic impact on the Portuguese healthcare system. Aims: To perform an economic analysis of the present and future impact of TAVR in Portugal and to propose health policy recommendations for a new reimbursement model. Methods: Hospital data from a high-volume center were used as a sample to calculate the costs of TAVR in Portugal. Information regarding the national penetration rate was derived from the EAPCI Valve for Life initiative. To estimate the future demand for TAVR, three scenarios (S) were constructed: S1, TAVR penetration according to current guidelines; S2, including intermediate-risk patients; and S3, including low-risk patients aged over 75 years. Results: The total cost of each TAVR procedure in Portugal was 22 134.50 euros for the self-expanding valve (SEV) and 23 321.50 euros for the balloon-expanding valves (BEV). Most of the cost was driven by the price of the valve (SEV 74.5% vs. BEV 81.5%). The current national economic impact is estimated at 12 500 000 euros per year. In S1, the expected penetration rate would be 189 procedures per million population; in S2 we estimated an increase of 28% to 241 procedures per million population and in S3 an increase of 107% to 391 procedures per million population. The total economic impact would increase to 43 770 586 euros in S1 and to 90 754 310 euros in S3. Conclusions: TAVR is associated with a significant present and future economic impact on the Portuguese healthcare system. A new model of reimbursement in Portugal should be discussed and implemented. Resumo: Introdução: A válvula aórtica percutânea (VAP) mudou o paradigma de tratamento da estenose aórtica grave. No entanto, em Portugal, a sua penetração é reduzida e dados acerca do impacto económico no Serviço Nacional de Saúde (SNS) são escassos. Objetivos: Analisar o impacto económico atual e futuro do implante de VAP em Portugal e propor um modelo de reembolso específico para as VAP. Métodos: Os custos fixos e variáveis do procedimento em Portugal foram calculados com base numa amostra de um centro de elevado volume de VAP. O impacto económico nacional foi calculado com base na penetração atual reportada na iniciativa EAPCI Valve for Life. As necessidades futuras da tecnologia foram estimadas em três cenários (S): S1 - penetração de acordo com as recomendações atuais; S2 - inclusão de doentes de risco intermédio; S3 - expansão aos doentes de baixo risco e idade > 75 anos. Resultados: O custo total da VAP em Portugal foi estimado em 22.134,5€ com prótese autoexpansível (SEV) e 23.321,5€ com prótese expansível por balão (BEV). A maior parte do custo relacionou-se com o preço da prótese (SEV 74,5% versus BEV 81,5%). O impacto económico nacional estima-se em 12.500.000€/ano. No cenário S1, a taxa esperada de penetração deveria ser 189/milhão; em S2 perspetiva-se aumento de +28% para 241 procedimentos/milhão; em S3 estima-se aumento de +107% para 391 procedimentos/milhão. Assim, o impacto económico poderá aumentar significativamente de 43.770.586€ (S1) até 90.754.310€ (S3). Conclusões: A VAP está associada a um impacto económico presente e futuro significativo no SNS. É essencial discutir e implantar um novo modelo específico de reembolso em Portugal.http://www.sciencedirect.com/science/article/pii/S2174204920303172Estenose aórticaVálvula aórtica percutânea (VAP)Análise económicaServiço Nacional de Saúde |