• QUALITY OF CARE AND OUTCOMES

During the past few years, transcatheter aortic valve implantation (TAVI) has become a mature procedure, results have become reproducible and safety has increased.1 Nevertheless, the overall cost for TAVI is still higher than the cost for surgical aortic valve replacement (SAVR), mainly due to the higher price of the valve. In this journal, Brecker et al2 published a UK cost utility analysis based on data from the ADVANCE registry (TAVI group) and from the PARTNER B study (medical management group). They found that TAVI is cost-effective, even in the high-risk subgroup of the ADVANCE registry. This analysis is of importance since it includes patients reflecting contemporary patient selection in Europe. Furthermore, unlike most countries, the UK and the USA have made explicit statements about their willingness to pay ratios (£20 000 and US$50 000, respectively). Thus, cost-effectiveness analyses in these countries may be of particular interest.

Although TAVI appears to be cost-effective, further reduction of index hospitalisation and follow-up costs are certainly desirable. Several strategies may achieve this. Some are evidence based, and some reflect personal and institutional experience (box 1).