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
The National Health Committee (NHC) is an independent statutory body which provides advice to the New Zealand Minister of Health. It was re-formed in 2011 to establish evaluation systems that would provide the New Zealand people and health sector with greater value for the money invested in health. The NHC executive are the secretariat that supports the committee. The NHC executive’s primary objective is to provide the committee with sufficient information for them to make recommendations regarding prioritisation and reprioritisation of interventions. They do this through a range of evidence-based reports tailored to the nature of the decision required and timeframe within which decisions need to be made. Citation: National Health Committee. 2015. Aortic Stenosis Overview: Tier 2 Wellington: National Health Committee Published in October 2015 by the National Health Committee PO Box 5013, Wellington, New Zealand ISBN (to be confirmed for final version) HP XXX This document is available on the National Health Committee’s website: http://www.nhc.health.govt.nz/ Disclaimer The information provided in this report is intended to provide general information to clinicians, health and disability service providers and the public, and is not intended to address specific circumstances of any particular individual or entity. All reasonable measures have been taken to ensure the quality and accuracy of the information provided. If you find any information that you believe may be inaccurate, please email to NHC_Info@nhc.govt.nz. The National Health Committee is an independent committee established by the Minister of Health. The information in this report is the work of the National Health Committee and does not necessarily represent the views of the Ministry of Health. The National Health Committee no warranty, expressed or implied, nor assumes any legal liability or responsibility for the accuracy, correctness, completeness or use of any information provided. Nothing contained in this report shall be relied on as a promise or representation by the New Zealand Government or the National Health Committee. The contents of this report should not be construed as legal or professional advice and specific advice from qualified professional people should be sought before undertaking any action following information in this report. Any reference to any specific commercial product, process, or service by name, trademark, manufacturer, or otherwise does not constitute an endorsement or recommendation by the New Zealand Government or the National Health Committee.