There is no reliable evidence to support the differences in price the NHS is paying for the various valves needed for keyhole heart surgery and the money saved by buying the most cost-effective solution could be used to fund more procedures and reduce waiting lists, according to the National Institute for Health and Care Excellence (NICE).
NICE’s committee reviewed the price paid by NHS England for the 11 different valves on offer, in its first use of the late-stage assessment programme, which hopes to inform future procurement decisions by evaluating the prices of technologies already in widespread NHS use.
No justification for price difference
While the specific prices are commercial in confidence, the difference between the cheapest and most expensive valve is several thousands of pounds. Despite the differential, NICE’s committee heard that many people are suitable for any of the available valves.
NICE’s deputy CEO and chief medical officer, Professor Jonathan Benger, said: “Thousands of people each year require TAVI procedures. These are highly effective but cost millions of pounds from the finite NHS budget.
“We have looked for evidence to determine whether differences in innovation and performance between these valves can justify their range in price, but the information we have seen does not support the current variation in cost.”
NICE hopes that this guidance can help commissioners agree cost-effective prices in the future and reinvest that money accordingly, added Prof Benger.
£100m+ spend
It is thought that over £100m is spent every year in England on heart valves for transcatheter aortic valve implantation (TAVI) in people with aortic stenosis. There were around 7,700 TAVI procedures performed by the NHS across England, Wales and Northern Ireland during 2022/23—a 13% increase from the previous year.
NICE previously considered the prices of valves in 2021 and concluded that for the TAVI procedure to be cost-effective for everyone, it would need to come in at around £14,800. NHS Supply Chain reported in November 2021 that the average cost of a TAVI device was £17,500.
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