Document Detail

The value of aortic valve replacement in elderly patients: an economic analysis.
MedLine Citation:
PMID:  17320551     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Economists have designed frameworks to measure the economic value of improvements in health and longevity. Heart valve replacement surgery has significantly prolonged life expectancy and quality of life. For the example of aortic valve replacement, what is its economic value according to this framework? METHODS: From 1961 through 2003, a total of 4617 adult patients underwent aortic valve replacement by one team of cardiac surgeons. These patients were provided with a prospective lifetime follow-up service. As of 2005, observed follow-up was 31,671 patient-years, with a maximum of 41 years. A statistical model was used to generate the future life-years of patients currently alive. The value of life-years proposed by economists was applied to determine the economic value of the additional life given to these patients by aortic valve replacement. RESULTS: The total life-years after aortic valve replacement were 53,323, with a gross value of 14.6 billion dollars. The total expected life-years without surgery were 10,157, with an estimated value of 3.0 billion dollars. Thus the net life-years gained by AVR were 43,166, worth 11.6 billion dollars. Subtracting the 451 million dollars total lifetime cost of surgery, the net value of the life-years gained by AVR was 11.2 billion dollars. The mean net value decreases according to age at surgery but is still worth 600,000 dollars for octogenarians and 200,000 dollars for nonagenarians. CONCLUSION: According to the economic concept of the value of a statistical life, the return on the investment for aortic valve replacement is enormous for patients of all ages, even very elderly patients.
YingXing Wu; Gary L Grunkemeier; Albert Starr
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  133     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-26     Completed Date:  2007-03-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  603-7     Citation Subset:  AIM; IM    
Providence Heart and Vascular Institute, Providence Health System, Portland, Ore 97225, USA.
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MeSH Terms
Age Factors
Aged, 80 and over
Aortic Valve / physiopathology,  surgery*
Cohort Studies
Cost-Benefit Analysis
Health Care Costs*
Heart Valve Diseases / diagnosis,  economics,  mortality*,  surgery*
Heart Valve Prosthesis Implantation / economics*,  methods,  mortality
Middle Aged
Quality-Adjusted Life Years*
Retrospective Studies
Risk Assessment
Survival Analysis
United States
Comment In:
J Thorac Cardiovasc Surg. 2007 Mar;133(3):601-2   [PMID:  17320550 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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