On June 24 2020 MD Gry Dahle at Institute of Clinical Medicine defended the thesis “The Introduction of Transcatheter Aortic Valve Implantation (TAVI) - Clinical, patient experience, economical and occupational hazard issues” for the degree of PhD (Philosophiae Doctor). The dissertation comes out of Instiutue of Clinical Medicine at Faculty of Medicine at University of Oslo. The title of the trial lecture was "Heart team decisions in daily clinical practice".
Innovation is a natural process in the evolution of health service to the society. It involves many stakeholders such as the patients, the physicians, the payers, the politicians, the engineers, the regulators, the scientific societies etc.
When introducing a new treatment option, it is of great importance to study the value of the new therapy both in a patient as well as a societal perspective at an early stage as possible. Thus, this study aimed at investigating and elucidating the cost of the new TAVI treatment, the objective results in heart function and complications, the quality of life for the patients and the hazards for the personnel in the hybrid operation room.
Objective measurements on health improvements in cardiac patients are in this study defined as quality of life and New York Heart Association (NYHA) functional class. Costs, changes in quality of life and clinical outcomes were recorded from the first day, and a clear picture of the potential value outcomes was obtained. As treatment initially was offered to patients with advanced disease, a number of patients were observed who did not benefit from the treatment.
A better selection is mandatory in order to save patients from a non-beneficial treatment and the burden of an unnecessary intervention. Our findings indicate that it may be possible to improve the selection, but further studies are warranted.
TAVI may have a great impact on hospital budget in the future, but if the value for the patient increases, the innovation may be justified.