Executive summary Aortic stenosis (AS) is responsible for the deaths of about 300 New Zealanders a year. The primary cause of AS is ageing, where calcium deposits build up in the aortic valve, narrowing it over time. Calcification of the valve happens more frequently in people who are born with abnormal aortic valves. Unlike other heart conditions, there are very few preventative strategies for AS. Patients face a poor prognosis once the disease becomes clinically evident, either with the onset of symptoms or with deterioration in left ventricular function. The life expectancy of patients with clinically evident AS without intervention is two to three years, with sudden death occurring in up to a third of these patients. For clinically evident AS, the standard of care is surgical aortic trial replacement, which is a highly effective intervention that can return patient quality of life and life expectancy to normal. Today, about $30 million is spent annually on aortic valve replacement (AVR) operations for patients with aortic stenosis. Assuming today’s cost for AVR, public expenditure is expected to increase to about $40 million per annum by 2025/26. The past decade has seen a significant increase in the number of AVR operations undertaken and a technology shift away from mechanical valves, towards bioprosthetic valves and less invasive surgery. At the same time, mortality from AS has declined significantly, from about four deaths per 100,000 New Zealanders in 2000 to about three deaths per 100,000 New Zealanders in 2011. As part of a global trend, two AVR technologies have emerged in New Zealand since 2008. These are transcatheter aortic valve implantation (TAVI) and sutureless AVR. Whilst the technologies hold promise for high-risk surgical patients, it is important that they are properly assessed to ensure their appropriate use. AVR is an exceptionally effective intervention for many patients. It is important, however, that new of AVR, namely TAVI and sutureless AVR, are used appropriately to continue to improve patient outcomes in the context of prudent use of available public funding. The main conclusion of this Tier 2 assessment, therefore, is that TAVI and sutureless AVR are assessed and that New Zealand relevant data be collected to guide their appropriate use.
Executive summary Aortic stenosis (AS) is responsible for the deaths of about 300 New Zealanders a year. The primary cause of AS is ageing, where calcium deposits build up in the aortic valve, narrowing it over time. Calcification of the valve happens more frequently in people who are born with abnormal aortic valves. Unlike other heart conditions, there are very few preventative strategies for AS. Patients face a poor prognosis once the disease becomes clinically evident, either with the onset of symptoms or with deterioration in left ventricular function. The life expectancy of patients with clinically evident AS without intervention is two to three years, with sudden death occurring in up to a third of these patients. For clinically evident AS, the standard of care is surgical aortic replacement, which is a highly effective intervention that can return patient quality of life and life expectancy to normal. Today, about $30 million is spent annually on aortic valve replacement (AVR) operations for patients with aortic stenosis. Assuming today’s cost for AVR, public expenditure is expected to increase to about $40 million per annum by 2025/26. The past decade has seen a significant increase in the number of AVR operations undertaken and a technology shift away from mechanical valves, towards bioprosthetic valves and less invasive surgery. At the same time, mortality from AS has declined significantly, from about four deaths per 100,000 New Zealanders in 2000 to about three deaths per 100,000 New Zealanders in 2011. As part of a global trend, two AVR technologies have emerged in New Zealand since 2008. These are transcatheter aortic valve implantation (TAVI) and sutureless AVR. Whilst the technologies hold promise for high-risk surgical patients, it is important that they are properly assessed to ensure their appropriate use. AVR is an exceptionally effective intervention for many patients. It is important, however, that new of AVR, namely TAVI and sutureless AVR, are used appropriately to continue to improve patient outcomes in the context of prudent use of available public funding. The main conclusion of this Tier 2 assessment, therefore, is that TAVI and sutureless AVR are assessed and that New Zealand relevant data be collected to guide their appropriate use. trial
aortic-stenosis-tier-2-overview.docx