Cost-Effectiveness of Mitral Valve Repair Versus Replacement for Severe Ischemic Mitral Regurgitation: A Randomized Clinical Trial From the Cardiothoracic Surgical Trials Network

Circulation. Cardiovascular Quality and Outcomes
Bart S. Ferket Cardiothoracic Surgical Trials Network (CTSN) Investigators

Abstract

The CTSN (Cardiothoracic Surgical Trials Network) recently reported no difference in left ventricular end-systolic volume index or in survival at 2 years between patients with severe ischemic mitral regurgitation (MR) randomized to mitral valve repair or replacement. However, replacement provided more durable correction of MR and fewer cardiovascular readmissions. Yet, costeffectiveness outcomes have not been addressed. We conducted a cost-effectiveness analysis of the surgical treatment of ischemic MR based on the CTSN trial (n=126 for repair; n=125 for replacement). Patient-level data on readmissions, survival, qualityof- life, and US hospital costs were used to estimate costs and quality-adjusted life years per patient over the trial duration and a 10-year time horizon. We performed microsimulation for extrapolation of outcomes beyond the 2 years of trial data. Bootstrap and deterministic sensitivity analyses were done to address parameter uncertainty. In-hospital cost estimates were $78 216 for replacement versus $72 761 for repair (difference: $5455; 95% uncertainty interval [UI]: −7784–21 193) while 2-year costs were $97 427 versus $96 261 (difference: $1166; 95% UI: −16 253–17 172), respectively. Quality-adjusted life ye...Continue Reading

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Citations

Mar 29, 2019·Surgical Endoscopy·Elisabeth M L de WijkersloothBas P L Wijnhoven
Mar 3, 2020·International Journal of Technology Assessment in Health Care·Laurence W BusseTimothy E Albertson
Dec 21, 2018·Circulation. Cardiovascular Quality and Outcomes·Matthew R Reynolds, Mark A Hlatky
Oct 27, 2020·Asian Cardiovascular & Thoracic Annals·Mohamed Abdelwahab HusseinYasser Shaban M Mubarak

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