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Ruyun Jin
Guangqiang Gao
Gary L. Grunkemeier
Albert Starr
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J Thorac Cardiovasc Surg 2007;133:608-613
© 2007 The American Association for Thoracic Surgery

Statistics for the Rest of Us

Cost-effectiveness of aortic valve replacement in the elderly: An introductory study

YingXing Wu, MD*, Ruyun Jin, MD, Guangqiang Gao, MD, Gary L. Grunkemeier, PhD, Albert Starr, MD

Providence Heart and Vascular Institute, Providence Health System, Portland, Ore.

Received for publication April 17, 2006; revisions received October 11, 2006; accepted for publication October 24, 2006.

* Address for reprints: YingXing Wu, Providence Health System, 9205 SW Barnes, Suite 33, Portland, OR 97225. (Email: yingxing.wu{at}providence.org).

Objective: With increased life expectancy and improved technology, valve replacement is being offered to increasing numbers of elderly patients with satisfactory clinical results. By using standard econometric techniques, we estimated the relative cost-effectiveness of aortic valve replacement by drawing on a large prospective database at our institution. By using aortic valve replacement as an example, this introductory report paves the way to more definitive studies of these issues in the future.

Methods: From 1961 to 2003, 4617 adult patients underwent aortic valve replacement at our service. These patients were provided with a prospective lifetime follow-up. As of 2005, these patients had accumulated 31,671 patient-years of follow-up (maximum 41 years) and had returned 22,396 yearly questionnaires. A statistical model was used to estimate the future life years of patients who are currently alive. In the absence of direct estimates of utility, quality-adjusted life years were estimated from New York Heart Association class. The cost-effectiveness ratio was calculated by the patient’s age at surgery.

Results: The overall cost-effectiveness ratio was approximately $13,528 per quality-adjusted life year gained. The cost-effectiveness ratio increased according to age at surgery, up to $19,826 per quality-adjusted life year for octogenarians and $27,182 per quality-adjusted life year for nonagenarians.

Conclusions: Given the limited scope of this introductory study, aortic valve replacement is cost-effective for all age groups and is very cost-effective for all but the most elderly according to standard econometric rules of thumb.

Abbreviations and Acronyms AVR = aortic valve replacement; CER = cost-effectiveness ratio; NYHA = New York Heart Association; QALY = quality-adjusted life year


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