***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To evaluate cost-effectiveness of transfemoral TAVR vs surgical replacement ( SAVR ) and its determinants in patients with severe symptomatic aortic stenosis and comparable risk . METHODS Patients were prospect ively recruited in 6 Spanish hospitals and followed up over one year . We estimated adjusted incremental cost-effectiveness ratio ( ICER ) ( Euros per quality -adjusted life-year [ QALY ] gained ) using a net-benefit approach and assessed the determinants of incremental net-benefit of TAVR vs SAVR . RESULTS We analyzed data on 207 patients : 58 , 87 and 62 in the Edwards SAPIEN ( ES ) TAVR , Medtronic-CoreValve ( MC ) TAVR and SAVR groups respectively .  Average cost per patient of ES-TAVR was € 8800 higher than SAVR and the gain in QALY was 0.036 . The ICER was € 148,525/QALY . The cost of MC-TAVR was € 9729 higher than SAVR and the QALY difference was -0.011 ( dominated ) . Results substantially changed in the following conditions : 1 ) in patients with high preoperative serum creatinine the ICERs were € 18,302/QALY and € 179,618/QALY for ES and MC-TAVR respectively ; 2 ) a 30 % reduction in the cost of TAVR devices decreased the ICER for ES-TAVR to € 32,955/QALY ; and 3 ) imputing hospitalization costs from other European countries leads to TAVR being dominant . CONCLUSIONS In countries with relatively low health care costs TAVR is not likely to be cost-effective compared to SAVR in patients with intermediate risk for surgery , mainly because of the high cost of the valve compared to the cost of hospitalization . TAVR could be cost-effective in specific subgroups and in countries with higher hospitalization costs BACKGROUND The use of transcatheter aortic-valve replacement has been shown to reduce mortality among high-risk patients with aortic stenosis who are not c and i date s for surgical replacement . However , the two procedures have not been compared in a r and omized trial involving high-risk patients who are still c and i date s for surgical replacement . METHODS At 25 centers , we r and omly assigned 699 high-risk patients with severe aortic stenosis to undergo either transcatheter aortic-valve replacement with a balloon-exp and able bovine pericardial valve ( either a transfemoral or a transapical approach )  or surgical replacement .  The primary end point was death from any cause at 1 year . The primary hypothesis was that transcatheter replacement is not inferior to surgical replacement . RESULTS The rates of death from any cause were 3.4 % in the transcatheter group and 6.5 % in the surgical group at 30 days ( P=0.07 ) and 24.2 % and 26.8 % , respectively , at 1 year ( P=0.44 ) , a reduction of 2.6 percentage points in the transcatheter group ( upper limit of the 95 % confidence interval , 3.0 percentage points ; predefined margin , 7.5 percentage points ; P=0.001 for noninferiority ) . The rates of major stroke were 3.8 % in the transcatheter group and 2.1 % in the surgical group at 30 days ( P=0.20 ) and 5.1 % and 2.4 % , respectively , at 1 year ( P=0.07 ) . At 30 days , major vascular complications were significantly more frequent with transcatheter replacement ( 11.0 % vs. 3.2 % , P<0.001 ) ; adverse events that were more frequent after surgical replacement included major bleeding ( 9.3 % vs. 19.5 % , P<0.001 ) and new-onset atrial fibrillation ( 8.6 % vs. 16.0 % , P=0.006 ) . More patients undergoing transcatheter replacement had an improvement in symptoms at 30 days , but by 1 year , there was not a significant between-group difference . CONCLUSIONS In high-risk patients with severe aortic stenosis , transcatheter and surgical procedures for aortic-valve replacement were associated with similar rates of survival at 1 year , although there were important differences in periprocedural risks . ( Funded by Edwards Lifesciences ; Clinical Trials.gov number , NCT00530894 . ) Background Patients with severe aortic stenosis and coexisting non-cardiac conditions may be at high risk for surgical replacement of the aortic valve or even be no c and i date s for surgery . In these patients , transcatheter aortic valve implantation ( TAVI ) is suggested as an alternative . Results of the PARTNER ( Placement of AoRTic TraNscathetER Valve ) trial comparing the clinical effectiveness of TAVI with surgical valve replacement and st and ard therapy were published . The authors assessed the cost-effectiveness of TAVI  in Belgium . Methods A Markov model of incremental costs , effects ( survival and quality of life ) and incremental cost-effectiveness of TAVI was developed . The impact on survival , number of events and quality of life was based on the PARTNER trial . Costs per event were context specific . Results In high-risk operable patients , even if the minor differences in 30-day and 1-year mortality are taken into account , the incremental cost-effectiveness ratio ( ICER ) remains on average above € 750 000 per quality -adjusted life-year ( QALY ) gained ( incremental cost : € 20 400 ; incremental effect : 0.03 QALYs ) . In inoperable patients , an ICER of € 44 900 per QALY ( incremental cost : € 33 200 ; incremental effect : 0.74 QALYs ) is calculated , including a life-long extrapolation of the mortality benefit . This result was sensitive to the assumed time horizon . The subgroup of anatomically inoperable patients had better outcomes than medically inoperable patients , with ICERs decreasing more than € 10 000/QALY . Conclusions It is inappropriate to consider reimbursement of TAVI for high-risk operable patients . Reimbursing TAVI in inoperable patients in essence is a political decision . From an economic perspective , it would be prudent to first target patients that are inoperable because of anatomical prohibitive conditions . In the search for evidence , the authors identified non-published negative results from a r and omised controlled TAVI trial . The study sponsor should be more willing to share this information to allow balanced evaluations and policy recommendations . Payers should require these data before taking reimbursement decisions AIMS To identify the characteristics , treatment , and outcomes of contemporary patients with valvular heart disease ( VHD ) in Europe , and to examine adherence to guidelines . METHODS AND RESULTS The Euro Heart Survey on VHD was conducted from April to July 2001 in 92 centres from 25 countries ; it included prospect ively 5001 adults with moderate to severe native VHD , infective endocarditis , or previous valve intervention . VHD was native in 71.9 % of patients and 28.1 % had had a previous intervention . Mean age was 64+/-14 years .  Degenerative aetiologies were the most frequent in aortic VHD and mitral regurgitation while most cases of mitral stenosis were of rheumatic origin . Coronary angiography was used in 85.2 % of patients before intervention . Of the 1269 patients who underwent intervention ,  prosthetic replacement  was performed in 99.0 % of aortic VHD , percutaneous dilatation in 33.9 % of mitral stenosis , and  valve repair  in 46.5 % of mitral regurgitation ; 31.7 % of patients had > or = 1 associated procedure . Of patients with severe , symptomatic , single VHD , 31.8 % did not undergo intervention , most frequently because of comorbidities . In asymptomatic patients , accordance with guidelines ranged between 66.0 and 78.5 % . Operative mortality was < 5 % for single VHD . CONCLUSIONS This survey provides unique contemporary data on characteristics and management of patients with VHD . Adherence to guidelines is globally satisfying as regards investigations and interventions Objective To determine the cost-effectiveness of transcatheter aortic valve implantation ( TAVI ) compared with surgical aortic valve replacement ( SAVR ) in a high-risk aortic stenosis ( AS ) population . Design A cost-utility analysis employing the National Institute of Clinical Excellence ( NICE ) reference case design for technology appraisal s. Setting The perspective of the UK National Health Service . Patients Utility data from a UK high-risk AS population .  TAVI and SAVR effectiveness was taken from the PARTNER A r and omised controlled trial . Main outcome measures Costs modelled over a 10 year horizon using a Markov model . Incremental cost-effectiveness ratios and cost-effectiveness acceptability curve were calculated with reference to the NICE willingness to pay per quality adjusted life year ( QALY ) gain threshold . Deterministic and probabilistic sensitivity analyses performed . Results Despite greater procedural costs ( £ 16 500 vs £ 9,256 ) , TAVI was cost-effective compared with SAVR over the 10 year model horizon ( costs £ 52 593 vs £ 53 943 and QALYs 2.81 vs 2.75 ) , indicating that TAVI dominated SAVR . This appeared to be due to greater postsurgical costs , related to the length and cost of hospital stay . The results appeared robust to a number of deterministic sensitivity and probabilistic analyses . The cost-effectiveness acceptability curve indicated that at the NICE £ 20 000 willingness to pay threshold per QALY gained , TAVI had a 64.6 % likelihood of being cost-effective , compared with 35.4 % for SAVR . Conclusions TAVI is likely to be a cost-effective treatment for high-risk patients with AS compared with the reference st and ard of SAVR . However , uncertainty surrounding the long-term outcomes for TAVI  patients remains ; this could have a substantive impact on estimates of cost-effectiveness Abstract Objective : The only effective treatment for severe aortic stenosis ( AS ) is valve replacement . However , many patients with co-existing conditions are ineligible for surgical valve replacement , historically leaving medical management ( MM ) as the only option which has a poor prognosis . Transcatheter Aortic Valve Replacement ( TAVR ) is a less invasive replacement method . The objective was to estimate cost-effectiveness of TAVR via transfemoral access vs MM in surgically inoperable patients with severe AS from the Canadian public healthcare system perspective . Methods : A cost-effectiveness analysis of TAVR vs MM was conducted using a deterministic decision analytic model over a 3-year time horizon . The PARTNER r and omized controlled trial results were used to estimate survival , utilities , and some re source utilization . Costs included the valve replacement procedure , complications , hospitalization , outpatient visits/tests , and home/nursing care . Re sources were valued ( 2009 Canadian dollars ) using costs from the Ontario Case Costing Initiative ( OCCI ) , Ontario Ministry of Health and Long-Term Care and Ontario Drug Benefits Formulary , or were estimated using relative costs from a French economic evaluation or clinical experts . Costs and outcomes were discounted 5 % annually . The effect of uncertainty in model parameters was explored in deterministic and probabilistic sensitivity analysis . Results : The incremental cost-effectiveness ratio ( ICER ) was $ 32,170 per quality -adjusted life year ( QALY ) gained for TAVR vs MM . When the time horizon was shortened to 24 and 12 months , the ICER increased to $ 52,848 and $ 157,429 , respectively . All other sensitivity analysis returned an ICER of less than $ 50,000/QALY gained . Limitations : A limitation was lack of availability of Canadian-specific re source and cost data for all re sources , leaving one to rely on clinical experts and data from France to inform certain parameters . Conclusions : Based on the results of this analysis , it can be concluded that TAVR is cost-effective compared to MM for the treatment of severe AS in surgically inoperable patients BACKGROUND Valvular heart diseases are not usually regarded as a major public-health problem . Our aim was to assess their prevalence and effect on overall survival in the general population . METHODS We pooled population -based studies to obtain data for 11 911 r and omly selected adults from the general population who had been assessed prospect ively with echocardiography .  We also analysed data from a community study of 16 501 adults who had been assessed by clinical ly indicated echocardiography .  FINDINGS In the general population group , moderate or severe valve disease was identified in 615 adults . There was no difference in the frequency of such diseases between men and women ( p=0.90 ) . Prevalence increased with age , from 0.7 % ( 95 % CI 0.5 - 1.0 ) in 18 - 44 year olds to 13.3 % ( 11.7 - 15.0 ) in the 75 years and older group ( p<0.0001 ) . The national prevalence of valve disease , corrected for age and sex distribution from the US 2000 population , is 2.5 % ( 2.2 - 2.7 ) . In the community group , valve disease was diagnosed in 1505 ( 
    Output:
    
Studies show that in high-risk patients with symptomatic aortic stenosis , TAVI may be cost-effective compared with medical management ( MM ) across many health care setting s. In contrast , studies of TAVI compared with surgical aortic valve replacement ( SAVR ) yield conflicting and inconclusive results .
The limited data available show that TMVR may also be cost-effective relative to MM in mitral valve disease .
Existing evidence indicates that transcatheter techniques may be cost-effective options , relative to MM , in high-risk patients with valvular disease .