{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:11:20Z","timestamp":1787069480969,"version":"build-2736575974"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,4,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for patients with severe aortic stenosis, which has become standard of care. The objective of this study was to determine the maximum cost\u2010effective investment in TAVI care that should be made at a health system level to meet quality indicator goals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">We performed a cost\u2010utility analysis using probabilistic patient\u2010level simulation of TAVI care from the Ontario, Canada, Ministry of Health perspective. Costs and health utilities were accrued over a 2\u2010year time horizon. We created 4 hypothetical strategies that represented TAVI care meeting \u22651 quality indicator targets, (1) reduced wait times, (2) reduced hospital length of stay, (3) reduced pacemaker use, and (4) combined strategy, and compared these with current TAVI care. Per\u2010person costs, quality\u2010adjusted life years, and clinical outcomes were estimated by the model. Using these, incremental net monetary benefits were calculated for each strategy at different cost\u2010effectiveness thresholds between $0 and $100\u00a0000 per quality\u2010adjusted life year. Clinical improvements over the current practice were estimated with all comparator strategies. In Ontario, achieving quality indicator benchmarks could avoid \u224826 wait\u2010list deaths and 200 wait\u2010list hospitalizations annually. Compared with current TAVI care, the incremental net monetary benefit for this strategy varied from $10\u00a0765 (\u00b1$8721) and $17\u00a0221 (\u00b1$8977). This would translate to an annual investment of between \u2248$14 to \u2248$22\u00a0million by the Ontario Ministry of Health to incentivize these performance measures being cost\u2010effective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">This study has quantified the modest annual investment required and substantial clinical benefit of meeting improvement goals in TAVI care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.121.025085","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T05:57:38Z","timestamp":1649743058000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Financial Incentives for Transcatheter Aortic Valve Implantation in Ontario, Canada: A Cost\u2010Utility Analysis"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1320-477X","authenticated-orcid":false,"given":"John K.","family":"Peel","sequence":"first","affiliation":[{"name":"Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada"},{"name":"Department of Anesthesiology and Pain Medicine University of Toronto Ontario Canada"},{"name":"Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2173-0021","authenticated-orcid":false,"given":"Rafael","family":"Neves Miranda","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada"},{"name":"Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0621-0637","authenticated-orcid":false,"given":"David","family":"Naimark","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada"},{"name":"Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada"},{"name":"Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Woodward","sequence":"additional","affiliation":[{"name":"CorHealth Ontario Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9241-8890","authenticated-orcid":false,"given":"Mamas A.","family":"Mamas","sequence":"additional","affiliation":[{"name":"Keele Cardiovascular Research Group Keele University Keele United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0285-6569","authenticated-orcid":false,"given":"Mina","family":"Madan","sequence":"additional","affiliation":[{"name":"Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8464-1080","authenticated-orcid":false,"given":"Harindra C.","family":"Wijeysundera","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada"},{"name":"Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada"},{"name":"Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2014-000043"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1008232"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000503"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2014.06.040"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2019.08.011"},{"key":"e_1_3_1_7_2","volume-title":"National quality report: transcatheter aortic valve implantation","author":"TAVI Quality Working Group","year":"2019","unstructured":"TAVI Quality Working Group . 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