Background: Clinical and economic outcomes of self-expanding bioprosthetic transcatheter aortic valve implantation (TAVI) in high-risk surgical candidates are unknown in the European setting. The objective of this study was to project life expectancy and to estimate the cost-effectiveness of TAVI in a European setting. Methods: Cost-utility analysis via probabilistic Markov modeling was performed. A simulated cohort of 83-year-old men and women (53 and 47%, respectively) with severe aortic stenosis at high but not extreme surgical risk were observed in the CoreValve High Risk Trial. Costs were based on resource use data from a Dutch academic medical center and costing guidelines. Undiscounted life expectancy and discounted costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and proportion cost-effective at a willingness-to-pay threshold of €50,000/QALY were evaluated. Beyond the base case, further analyses explored a “lean scenario” that considered a shorter TAVI ...