Cost-effectiveness of TTVR with EVOQUE system in patients with severe tricuspid regurgitation based on TRISCEND II trial
Abstract
Introduction: The Evoque™ transcatheter tricuspid valve replacement (TTVR) system demonstrated superiority over optimal medical treatment (OMT) in the TRISCEND II trial. We aimed to evaluate the cost-effectiveness of TTVR in patients with severe Tricuspid Regurgitation (TR) from the French healthcare perspective.
Methods: A state-transition Markov model was developed to assess the cost-effectiveness of Evoque™ TTVR versus OMT alone over a lifetime horizon. The modelled cohort reflected the TRISCEND II population. Health states were defined by TR severity (none/trace, mild, moderate, severe) and death. Transition probabilities, adverse events, and hospitalization rates were informed by TRISCEND II. Long-term survival outcomes were extrapolated by TR severity using published data. Utilities were estimated from the NYHA class distribution. Costs and health outcomes were discounted at 2.5% annually.
Results: Evoque™ was associated with an incremental 1.76 life-years gained (LYG) and 1.63 quality-adjusted LYG (QALY). Incremental costs were €39 382 driven by device acquisition and procedure costs, resulting in an incremental cost-effectiveness ratio (ICERs) of €22 327/LYG and €24 109/QALY gained. Assuming no mortality difference in extrapolations, the ICER would increase to €86 428/QALY (+258%). The model was highly sensitive to assumptions on time horizon, utility, discount rate, and post-trial mortality extrapolation, leading to major uncertainty.
Conclusion: Evoque™ may represent a cost-effective strategy in severe TR patients; however, this should be interpreted with caution, as results rely heavily on extrapolated data and are subject to high structural and parameter uncertainty. The projected long-term benefits are largely model driven rather than empirically demonstrated, emphasizing the need for extended follow-up data.
Related
- The TriArtic procedure: TRIcuspid annular reduction by TEER in the commissure-a transcatheter annuloplasty enabling EVOQUE tricuspid valve replacement: a case report.
- Risk factors and outcomes of tricuspid valve surgery in hypoplastic left heart syndrome patients with tricuspid regurgitation.
- Transcatheter Intervention Is Associated With Visceral Decongestion in Patients With Severe Tricuspid Regurgitation.
- Robotic tricuspid valve repair for infective endocarditis with leaflet perforation and severe tricuspid regurgitation
- Phenotypes of Secondary Tricuspid Regurgitation
BibTeX
@article{grangeon2026costeffectiveness,
title = {{Cost-effectiveness of TTVR with EVOQUE system in patients with severe tricuspid regurgitation based on TRISCEND II trial}},
author = {Apolline Grangeon and Martin Connock and Peter Auguste and Jean François Obadia and Maurice Enriquez-Sarano and Benjamin Essayagh and Xavier Armoiry},
journal = {ESC Heart Failure},
year = {2026},
month = may,
doi = {10.1093/eschf/xvag137},
url = {https://doi.org/10.1093/eschf/xvag137},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Cost-effectiveness of TTVR with EVOQUE system in patients with severe tricuspid regurgitation based on TRISCEND II trial
AU - Apolline Grangeon
AU - Martin Connock
AU - Peter Auguste
AU - Jean François Obadia
AU - Maurice Enriquez-Sarano
AU - Benjamin Essayagh
AU - Xavier Armoiry
PY - 2026
DA - 2026/05/13
JO - ESC Heart Failure
DO - 10.1093/eschf/xvag137
UR - https://doi.org/10.1093/eschf/xvag137
AB - Introduction: The Evoque™ transcatheter tricuspid valve replacement (TTVR) system demonstrated superiority over optimal medical treatment (OMT) in the TRISCEND II trial. We aimed to evaluate the cost-effectiveness of TTVR in patients with severe Tricuspid Regurgitation (TR) from the French healthcare perspective. Methods: A state-transition Markov model was developed to assess the cost-effectiveness of Evoque™ TTVR versus OMT alone over a lifetime horizon. The modelled cohort reflected the TRISCEND II population. Health states were defined by TR severity (none/trace, mild, moderate, severe) and death. Transition probabilities, adverse events, and hospitalization rates were informed by TRISCEND II. Long-term survival outcomes were extrapolated by TR severity using published data. Utilities were estimated from the NYHA class distribution. Costs and health outcomes were discounted at 2.5% annually. Results: Evoque™ was associated with an incremental 1.76 life-years gained (LYG) and 1.63 quality-adjusted LYG (QALY). Incremental costs were €39 382 driven by device acquisition and procedure costs, resulting in an incremental cost-effectiveness ratio (ICERs) of €22 327/LYG and €24 109/QALY gained. Assuming no mortality difference in extrapolations, the ICER would increase to €86 428/QALY (+258%). The model was highly sensitive to assumptions on time horizon, utility, discount rate, and post-trial mortality extrapolation, leading to major uncertainty. Conclusion: Evoque™ may represent a cost-effective strategy in severe TR patients; however, this should be interpreted with caution, as results rely heavily on extrapolated data and are subject to high structural and parameter uncertainty. The projected long-term benefits are largely model driven rather than empirically demonstrated, emphasizing the need for extended follow-up data.
SN - 2055-5822
ER -