{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T18:30:57Z","timestamp":1758479457471,"version":"3.37.3"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2019,5,3]],"date-time":"2019-05-03T00:00:00Z","timestamp":1556841600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To develop a cost-effectiveness model to address the outcome and economic implications of different thresholds for surgery in the management of aortopathy associated with bicuspid aortic valve disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>A model was created from the perspective of an Australian healthcare funding agency. The index case was a 65-year-old with bicuspid aortic valve (BAV) and ascending aorta diameter of 5.0\u2009cm. Health states were defined as: pre-operative with dilated aorta, post-operative without complications, post-complication, and death. The mean and variance of risks and transition probabilities were taken from a local surgical database and local costs and utilities of elective and urgent thoracic aortic surgery (AoS) with or without aortic valve replacement, with a sensitivity analysis based on a systematic review. Scenario analyses were provided for other aortic dimensions. Implications for survival, quality-adjusted life years (QALYs), and costs were calculated from healthcare delivery and economic perspectives. After 10\u00a0000 simulations for the reference case, the utility of watchful waiting (WW) exceeded that of elective AoS (13\u2009\u00b1\u20094 vs. 10\u2009\u00b1\u20095 QALY). The net monetary benefit was A$351\u00a0063\u2009\u00b1\u2009304\u00a0965 with immediate AoS vs. 534\u00a0797\u2009\u00b1\u2009198\u00a0570 with WW surveillance. The most important variables affecting effectiveness were utility value of survivors, rate of aortic growth, and probability of acute aortic event during WW.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This decision-analytic model informed by our practice, as well as a systematic analysis, shows that AoS in a BAV patient with aorta &lt;5\u2009cm diameter is costlier and less effective than WW.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcz020","type":"journal-article","created":{"date-parts":[[2019,4,30]],"date-time":"2019-04-30T15:27:07Z","timestamp":1556638027000},"page":"380-387","source":"Crossref","is-referenced-by-count":4,"title":["An economic analysis of medical and surgical management of aortopathy associated with bicuspid aortic valve"],"prefix":"10.1093","volume":"5","author":[{"given":"Ashutosh","family":"Hardikar","sequence":"first","affiliation":[{"name":"Cardiovascular Imaging group, Menzies Institute for Medical research, 17 Liverpool Street, Hobart, Tasmania, Australia"},{"name":"Department of Cardiothoracic Surgery, Royal Hobart Hospital, 48 Liverpool Street, Hobart, Tasmania, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9065-0899","authenticated-orcid":false,"given":"Thomas H","family":"Marwick","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging group, Menzies Institute for Medical research, 17 Liverpool Street, Hobart, Tasmania, Australia"},{"name":"Imaging Research, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,5,3]]},"reference":[{"key":"2019100309220345700_qcz020-B1","doi-asserted-by":"crossref","first-page":"2789","DOI":"10.1016\/j.jacc.2009.12.068","article-title":"Bicuspid aortic valve disease","volume":"55","author":"Siu","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2019100309220345700_qcz020-B2","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/0002-9149(91)90544-U","article-title":"Aorta in bicuspid aortic valve","volume":"67","author":"Pachulski","year":"1991","journal-title":"Am J Cardiol"},{"key":"2019100309220345700_qcz020-B3","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/S0022-5223(97)70360-X","article-title":"What is the appropriate size criterion for resection of thoracic aortic aneurysms?","volume":"113","author":"Coady","year":"1997","journal-title":"J Thorac Cardiovasc 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