An assessment of the cost of percutaneous pulmonary valve implantation (PPVI) versus surgical pulmonary valve replacement (PVR) in patients with right ventricular outflow tract dysfunction
Background: Percutaneous pulmonary valve implantation (PPVI) using the Melody* transcatheter pulmonary valve is a new procedure introduced in 2000 as a less invasive treatment for right ventricular outflow tract (RVOT) dysfunction. The aim of this new procedure is to restore pulmonary valve competence without the need of open-chest operation. By prolonging the conduit lifespan, it delays surgical pulmonary valve replacement (PVR) and it can therefore potentially reduce the number of open-chest interventions over a patient’s lifetime. PPVI has been shown to be feasible and safe and can be performed with a low complication rate. Objectives and methods: The aim of this study is to assess the cost of PPVI and the cost of surgical pulmonary valve replacement (PVR) in patients with right ventricular outflow tract dysfunction using a cohort simulation model applied to the UK population. Results: The model resulted in an estimate of mean cost per patient of £5,791 when PPVI is unavailable as a treatment option and in an estimate of mean cost per patient of £8,734 when PPVI is available over the 25-year period of analysis. After sensitivity analysis was undertaken the results showed that the mean per patient cost difference in implementing PPVI over 25 years as compared to surgical PVR lies somewhere between £2,041 and £3,913. Limitations: Given the lack of long-term data on treatment progression, the cost estimates derived here are subject to considerable uncertainty, and extensive sensitivity analysis has been used to counter this. Consequently this study is merely indicative of the levels of cost which can be expected in a cohort of 1,000 patients faced with a choice of treatment with PPVI or surgery. It is not a cost-effectiveness study but it helps place current knowledge on short-term benefits into context. Conclusions: As this analysis shows PPVI is associated with a relatively small increase in treatment management costs over a long time period. It is left entirely to the reader to value whether this inferred increase in long-term cost is worthwhile given the known short-term benefits and any personal judgement formed over long-term benefit.