Skip to content >>

an Economist Intelligence Unit business healthcare

Percutaneous aortic valve replacement



East Midlands Specialised Commissioning Group



Percutaneous Aotric Valve Replacement (PAVR) is a new and innovative technique for replacing defective heart valves whereby an artificial valve is mounted on a catheter and delivered to the heart via a major artery. In comparison to open heart surgery – the way valves are traditionally replaced – PAVR is minimally invasive. Consequently PAVR is mostly used in people deemed too frail for open heart surgery, however it has the potential to expand beyond this current indication to become a more commonly used procedure. 


The problem

One factor limiting the broader adoption of PAVR: its clinical efficacy is not clearly established. Randomised controlled trials are underway, but a blanket refusal to fund PAVR until the results are available risks stifling innovation and risks denying patients access to emerging best practice. Clearly a sensitive approach to funding PAVR is required – one which balances the need for innovation with the need for evidence-based service and pathway design.

East Midlands Specialised Commissioning (EMSCG) recognised the potential of PAVR and wanted to systematise the processes for funding it, moving from an ad-hoc approach to a more systematic one.


Our solution

A number of deliverables and tools would be required for change to happen, and stakeholders would have to be kept on board throughout the process. Working collaboratively with EMSCG we developed:

  • A robust and transparent evidence base for building a PAVR commissioning strategy
  • Evidence-based criteria for selecting candidate patients
  • A cost model to assess the budgetary impact of the procedure
  • The metrics needed to track effectiveness of PAVR over time and to monitor service provision
  • A framework for designating PAVR service providers
  • Workshops with local and national stakeholders for achieving a co-ordinated commissioning strategy 


The outcome

The project created real and lasting changes. The main outcomes were that:

  1. A balance between innovation and evidence-based policy has been found for PAVR
  2. EMSCG engaged commissioners and clinicians to co-create the commissioning strategy
  3. Key clinicians are championing the strategy in the East Midlands
  4. EMSCG elevated PAVR to the national level to get a tariff set for the procedure
  5. The materials have been developed to approach NIHR for funding to conduct studies to assess the effectiveness and cost effectiveness of PAVR over time



“The work done on PAVR with Bazian brought together commissioners, clinicians and academics to ensure that the commissioning of this new, innovative procedure will be based on sound evidence. This will benefit future NHS patients, and has demonstrated that we can introduce new technologies through a robust research-led approach. It also provided a model for introducing innovations to the NHS in the future through a collaborative process based on World Class Commissioning.”

Kate Caston, Director of EMSCG