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Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings.

Borisenko O, Haude M, Hoppe UC, Siminiak T, Lipiecki J, Goldberg SL, Mehta N, Bouknight OV, Bjessmo S, Reuter DG - BMC Cardiovasc Disord (2015)

Bottom Line: However, PMVR provided additional benefits to patients with an 1.15 incremental quality-adjusted life years (QALY) and an 1.41 incremental life years.The percutaneous procedure was cost-effective in comparison to OMT with an incremental cost-effectiveness ratio of €15,533/QALY.In the probabilistic sensitivity analysis with a willingness-to-pay threshold of €35,000/QALY, PMVR had a 84 % probability of being cost-effective.

View Article: PubMed Central - PubMed

Affiliation: Synergus AB, Svardvagen 19, 182 33, Danderyd, Sweden. oleg.borisenko@synergus.com.

ABSTRACT

Background: To determine the cost-effectiveness of the percutaneous mitral valve repair (PMVR) using Carillon® Mitral Contour System® (Cardiac Dimensions Inc., Kirkland, WA, USA) in patients with congestive heart failure accompanied by moderate to severe functional mitral regurgitation (FMR) compared to the prolongation of optimal medical treatment (OMT).

Methods: Cost-utility analysis using a combination of a decision tree and Markov process was performed. The clinical effectiveness was determined based on the results of the Transcatheter Implantation of Carillon Mitral Annuloplasty Device (TITAN) trial. The mean age of the target population was 62 years, 77% of the patients were males, 64% of the patients had severe FMR and all patients had New York Heart Association functional class III. The epidemiological, cost and utility data were derived from the literature. The analysis was performed from the German statutory health insurance perspective over 10-year time horizon.

Results: Over 10 years, the total cost was €36,785 in the PMVR arm and €18,944 in the OMT arm. However, PMVR provided additional benefits to patients with an 1.15 incremental quality-adjusted life years (QALY) and an 1.41 incremental life years. The percutaneous procedure was cost-effective in comparison to OMT with an incremental cost-effectiveness ratio of €15,533/QALY. Results were robust in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis with a willingness-to-pay threshold of €35,000/QALY, PMVR had a 84 % probability of being cost-effective.

Conclusions: Percutaneous mitral valve repair may be cost-effective in inoperable patients with FMR due to heart failure.

No MeSH data available.


Related in: MedlinePlus

Decision tree and Markov model structure. NYHA, New York Heart Association; OMT, optimal medical treatment; PMVR, percutaneous mitral valve repair
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Fig1: Decision tree and Markov model structure. NYHA, New York Heart Association; OMT, optimal medical treatment; PMVR, percutaneous mitral valve repair

Mentions: The combination of a decision tree and a Markov process [18–20] was used to assess the economic value of percutaneous annuloplasty in patients with FMR. The cycle length was one month. The model starts with a decision tree (Fig. 1), in which the patients undergoing PMVR may have several possible outcomes, including discharge from the hospital without complications, peri-operative complications with subsequent discharge from the hospital, unsuccessful device implantation with subsequent removal of the device during the initial procedure or death. All serious complications related to the implantation procedure were selected from the published TITAN trial [13]. During the first month of the model, the patients in the optimal medical treatment arm could die or stay alive. Decision tree estimates the cost-effectiveness for the first month in the model. Thereafter, all patients in both arms entered the Markov model.Fig. 1


Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings.

Borisenko O, Haude M, Hoppe UC, Siminiak T, Lipiecki J, Goldberg SL, Mehta N, Bouknight OV, Bjessmo S, Reuter DG - BMC Cardiovasc Disord (2015)

Decision tree and Markov model structure. NYHA, New York Heart Association; OMT, optimal medical treatment; PMVR, percutaneous mitral valve repair
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4443594&req=5

Fig1: Decision tree and Markov model structure. NYHA, New York Heart Association; OMT, optimal medical treatment; PMVR, percutaneous mitral valve repair
Mentions: The combination of a decision tree and a Markov process [18–20] was used to assess the economic value of percutaneous annuloplasty in patients with FMR. The cycle length was one month. The model starts with a decision tree (Fig. 1), in which the patients undergoing PMVR may have several possible outcomes, including discharge from the hospital without complications, peri-operative complications with subsequent discharge from the hospital, unsuccessful device implantation with subsequent removal of the device during the initial procedure or death. All serious complications related to the implantation procedure were selected from the published TITAN trial [13]. During the first month of the model, the patients in the optimal medical treatment arm could die or stay alive. Decision tree estimates the cost-effectiveness for the first month in the model. Thereafter, all patients in both arms entered the Markov model.Fig. 1

Bottom Line: However, PMVR provided additional benefits to patients with an 1.15 incremental quality-adjusted life years (QALY) and an 1.41 incremental life years.The percutaneous procedure was cost-effective in comparison to OMT with an incremental cost-effectiveness ratio of €15,533/QALY.In the probabilistic sensitivity analysis with a willingness-to-pay threshold of €35,000/QALY, PMVR had a 84 % probability of being cost-effective.

View Article: PubMed Central - PubMed

Affiliation: Synergus AB, Svardvagen 19, 182 33, Danderyd, Sweden. oleg.borisenko@synergus.com.

ABSTRACT

Background: To determine the cost-effectiveness of the percutaneous mitral valve repair (PMVR) using Carillon® Mitral Contour System® (Cardiac Dimensions Inc., Kirkland, WA, USA) in patients with congestive heart failure accompanied by moderate to severe functional mitral regurgitation (FMR) compared to the prolongation of optimal medical treatment (OMT).

Methods: Cost-utility analysis using a combination of a decision tree and Markov process was performed. The clinical effectiveness was determined based on the results of the Transcatheter Implantation of Carillon Mitral Annuloplasty Device (TITAN) trial. The mean age of the target population was 62 years, 77% of the patients were males, 64% of the patients had severe FMR and all patients had New York Heart Association functional class III. The epidemiological, cost and utility data were derived from the literature. The analysis was performed from the German statutory health insurance perspective over 10-year time horizon.

Results: Over 10 years, the total cost was €36,785 in the PMVR arm and €18,944 in the OMT arm. However, PMVR provided additional benefits to patients with an 1.15 incremental quality-adjusted life years (QALY) and an 1.41 incremental life years. The percutaneous procedure was cost-effective in comparison to OMT with an incremental cost-effectiveness ratio of €15,533/QALY. Results were robust in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis with a willingness-to-pay threshold of €35,000/QALY, PMVR had a 84 % probability of being cost-effective.

Conclusions: Percutaneous mitral valve repair may be cost-effective in inoperable patients with FMR due to heart failure.

No MeSH data available.


Related in: MedlinePlus