Patients with severe, symptomatic aortic stenosis have had two treatment options to choose from: Medical Management or Surgical Aortic Valve Replacement with open heart surgery. However, the latter option is often too detrimental, especially in older patients. For several years, the high-cost Transcatheter Aortic Valve Implantation (TAVI) has been a less invasive alternative for the patients.

The systematic review investigated health-economic evaluations on the cost-effectiveness of TAVI for inoperable patients and operable patients with high or moderate surgical risk. For the systematic review, all health-economic analyses published between 2007 and 2017 in English and German were taken into account. The relevance and quality of the evaluations were assessed using the ISPOR-checklist "Assessing the Evidence for Healthcare Decision Makers". To improve the comparability of costs, an inflation and price adjustment of international cost data to an Austrian level (year 2016) was conducted.

A total of 15 studies were identified, of which only eight were assessed with sufficient relevance and quality. Two of the eight studies considered several comparative interventions. The study results showed that: TAVI was cost-effective in inoperable patients compared to Medical Management (1 study), whereas TAVI was cost-effective in only 1 out of 5 studies compared to Standard Management in inoperable patients, and TAVI compared to Surgical Aortic Valve Replacement in patients with high surgical risk resulted in controversial results (4 studies). Sensitivity analyses showed that, in particular, the inclusion of follow-up treatments of serious complications such as stroke or the TAVI procedure costs may influence these results.

The transferability of the cost-effectiveness results to Austria can only be recommended with caution: On the one hand, only 8/15 health economic evaluations proved to be sufficiently reliable, on the other hand the results appeared not to be very robust –since the results can be strongly influenced by the inclusion and exclusion of cost parameters– and last because no cost-effectiveness thresholds are used in Austria. Overall, the careful selection of patients based on clinical parameters, as currently managed in Austria, can be considered as good practice.