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Treatment of Aortic Stenosis in Brazil: Cost-Utility Analysis of TAVI vs SAVR (TEAm-BR)

Primary Purpose

Aortic Stenosis

Status
Active
Phase
Not Applicable
Locations
Brazil
Study Type
Interventional
Intervention
TAVR - Transcatheter aortic valve replacement
Surgical aortic valve replacement
Sponsored by
Hospital do Coracao
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Aortic Stenosis focused on measuring aortic stenosis

Eligibility Criteria

70 Years - undefined (Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age > 70 years;
  • Symptoms of heart failure NYHA class > II;
  • Severe aortic stenosis (as defined by echocardiography: mean gradient >40 mmHg or jet velocity greater than 4.0 m/s or an initial aortic valve area of < 1.0 cm2)
  • Heart team (including examining cardiac surgeon) agree on eligibility including assessment that TAVR or SAVR is appropriate;
  • The study patient or the study patient's legal representative informed of the nature of the study, agreed to its provisions and provided written informed consent as approved by the Institutional Review Board (IRB) center;
  • The study patient agreed to comply with all required post-procedure follow-up visits including visits through 1 month and 1 year;
  • Heart team agreed (a priori) on treatment strategy for concomitant coronary disease (if present);
  • Patient agreed to undergo surgical aortic valve replacement (SAVR) if randomized to control treatment.

Exclusion Criteria:

  • Heart Team assessment of inoperability (including examining cardiac surgeon);
  • Hostile chest
  • Evidence of an acute myocardial infarction ≤ 1 month (30 days) before the intended treatment [defined as: Q wave MI, or non-Q wave MI with total CK elevation of CK-MB ≥ twice normal in the presence of MB elevation and/or troponin level elevation (WHO definition)];
  • Concomitant severe valvular disease (mitral, tricuspid or pulmonic) requiring surgical intervention;
  • Preexisting mechanical or bioprosthetic aortic valve with dysfunction;
  • Complex coronary artery disease: unprotected left main coronary artery, Syntax score > 32 (in the absence of prior revascularization);
  • Any therapeutic invasive cardiac procedure resulting in a permanent implant that is performed within 30 days of the index procedure (unless part of planned strategy for treatment of concomitant coronary artery disease). Implantation of a permanent pacemaker is not an exclusion criteria;
  • Leukopenia (WBC < 3000 cell/mL), acute anemia (Hgb < 9 g/dL), thrombocytopenia (Plt < 50,000 cell/mL);
  • Hypertrophic cardiomyopathy with or without obstruction (HOCM);
  • Severe ventricular dysfunction with LVEF < 20%;
  • Echocardiographic evidence of intracardiac mass, thrombus or vegetation;
  • Active upper GI bleeding within 3 months (90 days) prior to procedure;
  • A known contraindication or hypersensitivity to all anticoagulation regimens, or inability to be anticoagulated for the study procedure;
  • Clinically (by neurologist) or neuroimaging confirmed stroke or transient ischemic attack (TIA) within 6 months (180 days) of the procedure;
  • Renal insufficiency (creatinine > 3.0 mg/dL) and/or renal replacement therapy at the time of screening;
  • Estimated life expectancy < 24 months (730 days) due to carcinomas, chronic liver disease, chronic renal disease or chronic end stage pulmonary disease;
  • Currently participating in an investigational drug or another device study;
  • Active bacterial endocarditis within 6 months (180 days) of procedure;
  • Patient refuses surgery for aortic valve replacement.

Sites / Locations

  • Hospital do Coracao

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

TAVR - Transcatheter aortic valve replacement

Surgical aortic valve replacement

Arm Description

TAVR - Transcatheter aortic valve replacement with Acurate Neo bioprosthesis (Boston Scientific) using minimalist approach

Surgical aortic valve replacement

Outcomes

Primary Outcome Measures

Cost-utility of minimalist TAVR as compared to SAVR
Quality-adjusted life-years (QALYs). Quality of life will be assessed by EuroQol 5D.
Cost-utility of minimalist TAVR as compared to SAVR
Incremental cost-effectiveness ratio (ICER)

Secondary Outcome Measures

Clinical outcomes
All-cause mortality, cardiovascular mortality, disabling stroke, acute renal failure, bleeding, major vascular complications, atrial fibrillation and permanent pacemaker implantation

Full Information

First Posted
August 11, 2019
Last Updated
March 1, 2023
Sponsor
Hospital do Coracao
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1. Study Identification

Unique Protocol Identification Number
NCT04067089
Brief Title
Treatment of Aortic Stenosis in Brazil: Cost-Utility Analysis of TAVI vs SAVR
Acronym
TEAm-BR
Official Title
Prospective, Randomized, Cost-utility Analysis of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Brazil
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
December 10, 2018 (Actual)
Primary Completion Date
September 13, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hospital do Coracao

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
TEAM-Br is a randomized, prospective, cost-utility study comparing transcatheter aortic valve implantation (TAVI) versus surgical aortic vale replacement in Brazil. The study is sponsored by the national Minister of Health, through PROADI-SUS (Programa de Apoio ao Desenvolvimento Institucional do SUS).
Detailed Description
Transcatheter aortic valve implantation has been shown to be non-inferior to surgical aortic valve replacement in patients with severe aortic stenosis at high, intermediate and low surgical risk. In recent years, a concept of a simplified and optimized TAVR procedure (known as minimalist approach) has led experienced centers to perform the majority of these procedures using conscious sedation and local anesthesia only. From a clinical perspective, this approach is associated with better and faster recovery and mobilization, reduced need for a prolonged intensive care unit (ICU) stay and faster hospital discharge, as compared to general anesthesia. The cost-effectiveness of minimalist TAVR strategy - as compared to surgery - in Brazil is uncertain. Our objective is to conduct a cost-utility analysis comparing minimalist transcatheter aortic valve implantation with surgical aortic valve replacement in patients with severe aortic stenosis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Aortic Stenosis
Keywords
aortic stenosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Randomized controlled trial
Masking
None (Open Label)
Allocation
Randomized
Enrollment
126 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
TAVR - Transcatheter aortic valve replacement
Arm Type
Experimental
Arm Description
TAVR - Transcatheter aortic valve replacement with Acurate Neo bioprosthesis (Boston Scientific) using minimalist approach
Arm Title
Surgical aortic valve replacement
Arm Type
Active Comparator
Arm Description
Surgical aortic valve replacement
Intervention Type
Procedure
Intervention Name(s)
TAVR - Transcatheter aortic valve replacement
Other Intervention Name(s)
TAVR
Intervention Description
TAVR - Transcatheter aortic valve replacement with Acurate Neo bioprosthesis (Boston Scientific) using minimalist approach
Intervention Type
Procedure
Intervention Name(s)
Surgical aortic valve replacement
Other Intervention Name(s)
SAVR
Intervention Description
Surgical aortic valve replacement
Primary Outcome Measure Information:
Title
Cost-utility of minimalist TAVR as compared to SAVR
Description
Quality-adjusted life-years (QALYs). Quality of life will be assessed by EuroQol 5D.
Time Frame
1 year
Title
Cost-utility of minimalist TAVR as compared to SAVR
Description
Incremental cost-effectiveness ratio (ICER)
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Clinical outcomes
Description
All-cause mortality, cardiovascular mortality, disabling stroke, acute renal failure, bleeding, major vascular complications, atrial fibrillation and permanent pacemaker implantation
Time Frame
30 days and 1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age > 70 years; Symptoms of heart failure NYHA class > II; Severe aortic stenosis (as defined by echocardiography: mean gradient >40 mmHg or jet velocity greater than 4.0 m/s or an initial aortic valve area of < 1.0 cm2) Heart team (including examining cardiac surgeon) agree on eligibility including assessment that TAVR or SAVR is appropriate; The study patient or the study patient's legal representative informed of the nature of the study, agreed to its provisions and provided written informed consent as approved by the Institutional Review Board (IRB) center; The study patient agreed to comply with all required post-procedure follow-up visits including visits through 1 month and 1 year; Heart team agreed (a priori) on treatment strategy for concomitant coronary disease (if present); Patient agreed to undergo surgical aortic valve replacement (SAVR) if randomized to control treatment. Exclusion Criteria: Heart Team assessment of inoperability (including examining cardiac surgeon); Hostile chest Evidence of an acute myocardial infarction ≤ 1 month (30 days) before the intended treatment [defined as: Q wave MI, or non-Q wave MI with total CK elevation of CK-MB ≥ twice normal in the presence of MB elevation and/or troponin level elevation (WHO definition)]; Concomitant severe valvular disease (mitral, tricuspid or pulmonic) requiring surgical intervention; Preexisting mechanical or bioprosthetic aortic valve with dysfunction; Complex coronary artery disease: unprotected left main coronary artery, Syntax score > 32 (in the absence of prior revascularization); Any therapeutic invasive cardiac procedure resulting in a permanent implant that is performed within 30 days of the index procedure (unless part of planned strategy for treatment of concomitant coronary artery disease). Implantation of a permanent pacemaker is not an exclusion criteria; Leukopenia (WBC < 3000 cell/mL), acute anemia (Hgb < 9 g/dL), thrombocytopenia (Plt < 50,000 cell/mL); Hypertrophic cardiomyopathy with or without obstruction (HOCM); Severe ventricular dysfunction with LVEF < 20%; Echocardiographic evidence of intracardiac mass, thrombus or vegetation; Active upper GI bleeding within 3 months (90 days) prior to procedure; A known contraindication or hypersensitivity to all anticoagulation regimens, or inability to be anticoagulated for the study procedure; Clinically (by neurologist) or neuroimaging confirmed stroke or transient ischemic attack (TIA) within 6 months (180 days) of the procedure; Renal insufficiency (creatinine > 3.0 mg/dL) and/or renal replacement therapy at the time of screening; Estimated life expectancy < 24 months (730 days) due to carcinomas, chronic liver disease, chronic renal disease or chronic end stage pulmonary disease; Currently participating in an investigational drug or another device study; Active bacterial endocarditis within 6 months (180 days) of procedure; Patient refuses surgery for aortic valve replacement.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alexandre A Abizaid, MD, PhD
Organizational Affiliation
Hospital do Coracao
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Fabio Jatene, MD, PhD
Organizational Affiliation
Hospital do Coracao
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Dimytri A Siqueira, MD PhD
Organizational Affiliation
Hospital do Coracao
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Paulo P Fernandes, Md, PhD
Organizational Affiliation
Hospital do Coracao
Official's Role
Study Chair
Facility Information:
Facility Name
Hospital do Coracao
City
Sao Paulo
State/Province
SP
ZIP/Postal Code
04005-000
Country
Brazil

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Reproducible Research Statement:We will share the database containing de-identified individual participant data, data dictionary documentation, statistical analysis plan, and analysis code. Beginning 6 months and ending 24 months following article publication, the trial steering committee will evaluate proposals of studies accompanied by a statistical analysis plan and may grant access to the data for approved proposals. After 24 months, the database and accompanying documents will be publicly available in an institutional data repository (http://www.hcor.com.br).
IPD Sharing Time Frame
Beginning 6 months and ending 24 months following article publication, the trial steering committee will evaluate proposals of studies accompanied by a statistical analysis plan and may grant access to the data for approved proposals. After 24 months, the database and accompanying documents will be publicly available in an institutional data repository (http://www.hcor.com.br).
IPD Sharing URL
http://www.hcor.com.br

Learn more about this trial

Treatment of Aortic Stenosis in Brazil: Cost-Utility Analysis of TAVI vs SAVR

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