Cost-effectiveness of rapid-deployment aortic valve replacement over TAVI: a real-world retrospective cohort study

Aortic valve replacement (AVR) is the standard treatment for severe aortic stenosis. While transcatheter aortic valve implantation (TAVI) has recently been widely recommended, concerns remain regarding real-world long-term valve durability and cost-effectiveness. Rapid deployment valves (RDV) have emerged as an alternative in surgical AVR, offering potential advantages in operative efficiency. This retrospective cohort study compares the clinical outcomes and cost-effectiveness of TAVI versus RDV on patients undergoing AVR between 2012 and 2024 in a single center in Bogota, Colombia. The primary outcomes were all-cause mortality, structural valve deterioration (SVD), and non-structural valve deterioration (NSVD). Multivariable regression models were used to identify predictors of each outcome. The inverse probability of treatment weighting (IPTW) was used to further balance baseline differences. A cost-effectiveness analysis was performed on the IPTW-weighted sample. Probabilistic sensitivity analyses were conducted to assess uncertainty. 117 patients were included (TAVI: n = 70, RDV: n = 47). TAVI patients were older and had a higher preoperative risk profile than RDV patients. No significant differences were observed in 30-day or follow-up all-cause mortality. In unweighted analyses, SVD occurred more frequently in the TAVI group (aHR: 4.41, 95% CI: 1.22–16.0; p = 0.024), while NSVD was observed exclusively in TAVI patients (p = 0.0017). After IPTW, TAVI was associated with a significantly higher hazard of any form of valve deterioration (aHR: 5.08, 95% CI: 1.41–18.32; p = 0.013). The mean cost of RDV was $42,629, while the cost of TAVI was $73,403. The cost-effectiveness analysis indicated that TAVI was less effective and more expensive and was unlikely to be cost-effective at local willingness-to-pay (WTP) thresholds ($6,947–$20,842). Sensitivity analysis confirmed that RDV was the preferred strategy in 66.6% and 68.5% of simulations under the corresponding WTP thresholds. Both RDV and TAVI exhibit comparable safety and mortality profiles. However, TAVI is associated with a higher incidence of valve deterioration and significantly higher costs, making it a less cost-effective option, particularly for the Colombian healthcare system. These findings highlight the importance of individualized procedural selection based on patient characteristics and economic factors. Future research should focus on long-term real-world cost-effectiveness in different socioeconomical contexts and strategies to mitigate valve deterioration in TAVI.