{"id":"884f8db70342","type":"article","url":"https://hartvaat.nl/2026/05/13/evoque-transcatheter-tricuspidalisklep-mogelijk-kosteneffectief-bij-ernstige-tr-/","title":"Evoque transcatheter-tricuspidalisklep mogelijk kosteneffectief bij ernstige TR — maar resultaten leunen sterk op extrapolatie","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["farmaco-economie"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag137","source_url":"https://doi.org/10.1093/eschf/xvag137","authors":["Apolline Grangeon","Martin Connock","Peter Auguste","Jean François Obadia","Maurice Enriquez-Sarano","Benjamin Essayagh","Xavier Armoiry"],"significance":6,"published":"2026-06-22","source_date":"2026-05-13","image":"","kennis":[],"congress":"","summary_en":"Markov model from a French payer perspective on the cost-effectiveness of the Evoque transcatheter tricuspid valve replacement (TTVR) versus optimal medical therapy (OMT) in severe tricuspid regurgitation, based on TRISCEND II. Over a lifetime horizon, TTVR yielded 1.76 additional life-years and 1.63 additional QALYs at €39,382 incremental costs, giving an ICER of €22,327/life-year and €24,109/QALY — below the French threshold. However: when no mortality difference is assumed in the extrapolation, the ICER rises to €86,428/QALY (+258%). Results are highly sensitive to time horizon, utility, discount rate, and post-trial mortality extrapolation. Conclusion: Evoque-TTVR appears potentially cost-effective, but the long-term benefit is largely model-driven rather than empirically demonstrated — longer follow-up is needed.","created":"2026-07-03T10:33:06Z","updated":"2026-07-03T13:32:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Markov-model vanuit Frans zorgperspectief over kosteneffectiviteit van Evoque transcatheter-tricuspidalisklepvervanging (TTVR) versus optimale medicamenteuze therapie (OMT) bij ernstige tricuspidalisinsufficiëntie, gebaseerd op TRISCEND II. Over lifetime-horizon leverde TTVR 1,76 extra levensjaren en 1,63 extra QALY's op bij €39.382 extra kosten, met ICER €22.327/levensjaar en €24.109/QALY — onder de Franse drempel. Echter: wanneer in de extrapolatie geen mortaliteitsverschil wordt aangenomen, stijgt de ICER naar €86.428/QALY (+258%). De resultaten zijn sterk gevoelig voor tijdshorizon, utiliteit, discontering en post-trial mortaliteitsextrapolatie. Conclusie: Evoque-TTVR lijkt potentieel kosteneffectief, maar de langetermijnwinst is grotendeels model-gedreven en niet empirisch aangetoond — langere follow-up is nodig.","abstract_original":"AIMS: The Evoque™ transcatheter tricuspid valve replacement (TTVR) system demonstrated superiority over optimal medical treatment (OMT) in the TRISCEND II trial. We aimed to evaluate the cost-effectiveness of TTVR in patients with severe Tricuspid Regurgitation (TR) from the French healthcare perspective. METHODS AND RESULTS: A state-transition Markov model was developed to assess the cost-effectiveness of Evoque™ TTVR versus OMT alone over a lifetime horizon. The modeled cohort reflected the TRISCEND II population. Health states were defined by TR severity (none/trace, mild, moderate, severe) and death. Transition probabilities, adverse events, and hospitalisation rates were informed by TRISCEND II. Long-term survival outcomes were extrapolated by TR severity using published data. Utilities were estimated from NYHA class distribution. Costs and health outcomes were discounted at 2.5% annually.Evoque™ was associated with an incremental 1.76 life-years gained (LYG) and 1.63 quality-adjusted LYG (QALY). Incremental costs were €39,382 driven by device acquisition and procedure costs, resulting in an incremental cost-effectiveness ratio (ICERs) of €22,327/LYG and €24,109/QALY gained. Assuming no mortality difference in extrapolations, the ICER would increase to €86,428/QALY (+258%). The model was highly sensitive to assumptions on time horizon, utility, discount rate and post-trial mortality extrapolation, leading to major uncertainty. CONCLUSION: Evoque™ may represent a cost-effective strategy in severe TR patients, however this should be interpreted with caution, as results rely heavily on extrapolated data and are subject to high structural and parameter uncertainty. The projected long-term benefits are largely model driven rather than empirically demonstrated, emphasising the need for extended follow-up data."}