Patient preferences for heart valve disease intervention

Abstract Background This study aimed to determine how patients trade‐off the benefits and risks of two different types of procedures used to treat heart valve disease (HVD). It also aimed to determine patients' preferences for HVD treatments (predicted uptake) and the relative importance of each treatment attribute. Methods A discrete choice experiment (DCE) was conducted in Australia and Japan with patients who required a heart valve procedure. Patients were stratified into three categories: no prior procedure experience, minimally invasive procedure experience and invasive procedure experience. DCE attributes included risk of mortality; risk of stroke; needing dialysis; needing a new pacemaker; valve durability; independence 1 month after surgery; and out‐of‐pocket expenses. Participants chose between two hypothetical labelled approaches to therapy (‘invasive procedure’ and ‘minimally invasive procedure’), with a separate opt‐out included. A mixed multinomial logit model was used to analyse preferences. Results The DCE was completed by 143 Australian and 206 Japanese patients. Both populations demonstrated an overall preference for the minimally invasive procedure over the invasive procedure. All attributes tested significantly predicted choice and were important to patient decision‐making. However, patients' choices were most influenced by the durability of the valve and the likelihood of independence postprocedure, irrespective of their prior procedure experience. Differences in preference were observed between Australian and Japanese patients; valve durability was the most important attribute among Australian patients, while Japanese patients emphasised regaining independence postsurgery. Risk of mortality was less important relative to other key attributes in Japan; however, it remained significant to the model. Conclusions HVD patients prefer a minimally invasive procedure over an invasive procedure, irrespective of prior treatment experience. Key attributes contributing to treatment preferences are valve durability and faster recovery. These results can be used to help inform healthcare decision‐makers about what features of heart valve procedures patients value most. Patient and Public Contribution People with lived experience of HVD were included in multiple stages of the design phase of this research. First, patients and doctors were consulted by taking part in qualitative interviews. The qualitative interviews helped inform which treatment attributes to include in the DCE based on what was important to those with lived experience and those who help make treatment decisions on behalf of patients. Qualitative interview participants also assisted with the framing of questions in the online survey to ensure the terminology was patient‐friendly and relevant to those with lived experience. Following qualitative interviews, the DCE attribute list was agreed on in expert consultation with a steering committee, which included patient representatives and treating physicians (interventional cardiologists, cardiothoracic surgeons). The survey was also pilot tested with a small sample of patients and minor adjustments were made to the wording to ensure it was appropriate and meaningful to those with lived experience of HVD

Cost-effectiveness analysis of transcatheter aortic valve implantation in aortic stenosis patients at low- and intermediate-surgical risk in Japan

To analyze the cost-effectiveness of transcatheter aortic valve implantation (TAVI) using the SAPIEN 3 (Edwards Lifesciences, Irvine, CA) compared to surgical aortic valve replacement (SAVR) in low- and intermediate-risk patients from a Japanese public healthcare payer perspective. A Markov model cost-effectiveness analysis was developed. Clinical and utility data were extracted from a systematic literature review. Cost inputs were obtained from analysis of the Medical Data Vision claims database and supplemented with a targeted literature search. The robustness of the results was assessed using sensitivity analyses. Scenario analyses were performed to determine the impact of lower mean age (77.5 years) and the effect of two different long-term mortality hazard ratios (TAVI versus SAVR: 0.9–1.09) on both risk-level populations. This analysis was conducted according to the guidelines for cost-effectiveness evaluation in Japan from Core 2 Health. In intermediate-risk patients, TAVI was a dominant procedure (TAVI had lower cost and higher effectiveness). In low-risk patients, the incremental cost effectiveness ratio (ICER) for TAVI was ¥750,417/quality-adjusted-life-years (QALY), which was below the cost-effectiveness threshold of ¥5 million/QALY. The ICER for TAVI was robust to all tested sensitivity and scenario analyses. TAVI was dominant and cost-effective compared to SAVR in intermediate- and low-risk patients, respectively. These results suggest that TAVI can provide meaningful value to Japanese patients relative to SAVR, at a reasonable incremental cost for patients at low surgical risk and potentially resulting in cost-savings in patients at intermediate surgical risk. Cost-effectiveness analysis of transcatheter aortic valve implantation in aortic stenosis patients at low- and intermediate-surgical risk in Japan. Results demonstrate that TAVI can provide meaningful value to Japanese patients with severe symptomatic aortic stenosis relative to SAVR, at a reasonable incremental cost for low-risk patients and potentially resulting in cost-savings in intermediate-risk patients. Aortic Stenosis (AS) is the most common valvular heart disease in Japan, and, if left untreated, severe symptomatic AS (sSAS) is associated with a dramatic increase in mortality and morbidity. Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive treatment option for replacing the aortic valve in patients with sSAS and has been associated with similar or better outcomes compared to Surgical Aortic Valve Replacement (SAVR), which involves open-heart surgical replacement of the aortic valve. The objective of this study was to compare the costs and health outcomes associated with TAVI compared to SAVR in Japanese patients deemed low- or intermediate-risk for surgery. Despite the expanding use of TAVI in Japan, a cost-effectiveness analysis (CEA) does not exist that evaluates the economics of TAVI with the current generation SAPIEN 3 implant in patients with low- and intermediate-risk from a public perspective. Our study suggests that TAVI represents strong value for money among low- and intermediate-risk patients in Japan: compared to SAVR, TAVI is associated with better clinical outcomes and quality of life for patients, at a reasonable additional cost for low-risk patients and at a lower cost for intermediate-risk patients.</p

Assessment Report of Doctoral Theses

褐炭液化重質生成物の性状分析に関する研究[増田]ビスベンゾチエニルエテンのフォトクロミズムに関する研究[内田]新しい素材と加工法を用いた省エネルギー機器および環境保全機器の開発[隈]微量He原子測定装置の開発およびHe生成断面積測定に関する研究[鷹尾]A Numerical Experiment Study on the Circulation of the Japan Sea (East Sea)[金]垂直平板上の気液2相流中移動現象に関する研究[松浦]Experimental Investigation of Supersonic Nozzle Flow with Shock Wave/Turbulent Boundary Layer Interaction[洪]A Study on Design Support for Computer Architecture Design[赤星]Graph Inference from Walks[丸山]超並列計算機用細粒度処理プロセッサの構成方式に関する研究[川野]側鎖重水素標識ベンジルアルコール類の合成化学的研究[石本]重水素標識ブロックの合成化学的研究[椋本]特異な場を構築するメタシクロファン類の合成と特性に関する研究[石井]プロトン導電体を用いた室温作動型ガスセンサの開発[原田]水晶振動子を用いたガスおよびバイオセンサに関する研究[酒井]有機薄膜エレクトロルミネッセンス素子のキャリア再結合領域とその発光量子効率への影響[網中]Optimization of Composition for Spontaneous Emission Probabilities of Rare-Earth Ions in Silicate, Borate, and Phosphate Glasses[投野]Preparation of Nitrogen-Containing Pitches from Heterocyclic Nitrogen Compounds and Their Derived ACFs[安]転位線が存在する鉄中の陽電子寿命に関する計算機を用いた研究[上村]低エネルギー水素イオン照射による材料損傷と水素吸蔵に関する研究[坂本]Experimental Study on Geysering in Thermosyphon[Heru]電磁場との相互作用がある超音速流れに関する研究[右近]電磁場を介した核融合エネルギーの直接変換利用に関する研究[庄山]Experimental Investigation of Stall and Surge in Centrifugal Blower With and Without Low Solidity Cascade Diffusers[Ahmed]固体の熱伝導率と熱拡散率の非接触同時測定法に関する研究[朴]A Numerical Simulation for the Water Masses and Circulations of the Yellow Sea and the East China Sea[李]新しい非線形伝達計算法に基づく次世代型波浪予報モデルの開発[小松]1,2-ジオキセタンを中間体とする分子の化学発光機構に関する研究[山辺

学位論文審査報告

褐炭液化重質生成物の性状分析に関する研究[増田]ビスベンゾチエニルエテンのフォトクロミズムに関する研究[内田]新しい素材と加工法を用いた省エネルギー機器および環境保全機器の開発[隈]微量He原子測定装置の開発およびHe生成断面積測定に関する研究[鷹尾]A Numerical Experiment Study on the Circulation of the Japan Sea (East Sea)[金]垂直平板上の気液2相流中移動現象に関する研究[松浦]Experimental Investigation of Supersonic Nozzle Flow with Shock Wave/Turbulent Boundary Layer Interaction[洪]A Study on Design Support for Computer Architecture Design[赤星]Graph Inference from Walks[丸山]超並列計算機用細粒度処理プロセッサの構成方式に関する研究[川野]側鎖重水素標識ベンジルアルコール類の合成化学的研究[石本]重水素標識ブロックの合成化学的研究[椋本]特異な場を構築するメタシクロファン類の合成と特性に関する研究[石井]プロトン導電体を用いた室温作動型ガスセンサの開発[原田]水晶振動子を用いたガスおよびバイオセンサに関する研究[酒井]有機薄膜エレクトロルミネッセンス素子のキャリア再結合領域とその発光量子効率への影響[網中]Optimization of Composition for Spontaneous Emission Probabilities of Rare-Earth Ions in Silicate, Borate, and Phosphate Glasses[投野]Preparation of Nitrogen-Containing Pitches from Heterocyclic Nitrogen Compounds and Their Derived ACFs[安]転位線が存在する鉄中の陽電子寿命に関する計算機を用いた研究[上村]低エネルギー水素イオン照射による材料損傷と水素吸蔵に関する研究[坂本]Experimental Study on Geysering in Thermosyphon[Heru]電磁場との相互作用がある超音速流れに関する研究[右近]電磁場を介した核融合エネルギーの直接変換利用に関する研究[庄山]Experimental Investigation of Stall and Surge in Centrifugal Blower With and Without Low Solidity Cascade Diffusers[Ahmed]固体の熱伝導率と熱拡散率の非接触同時測定法に関する研究[朴]A Numerical Simulation for the Water Masses and Circulations of the Yellow Sea and the East China Sea[李]新しい非線形伝達計算法に基づく次世代型波浪予報モデルの開発[小松]1,2-ジオキセタンを中間体とする分子の化学発光機構に関する研究[山辺