Cost-effectiveness of percutaneous mitral repair for patients with severe secondary mitral regurgitation: an updated evaluation using a modelling approach based on COAPT final data after 5-year follow-up
Objectives To evaluate the cost-effectiveness of percutaneous repair (PR) for secondary mitral regurgitation.Design An economic evaluation using a time-varying Markov model comprising three states to assess the cost and effectiveness of PR added to guideline-directed medical treatment (GDMT) compare...
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/12/e087695.full |
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| author | Xavier Armoiry Peter Auguste Martin Connock Jean-Francois Obadia |
| author_facet | Xavier Armoiry Peter Auguste Martin Connock Jean-Francois Obadia |
| author_sort | Xavier Armoiry |
| collection | DOAJ |
| description | Objectives To evaluate the cost-effectiveness of percutaneous repair (PR) for secondary mitral regurgitation.Design An economic evaluation using a time-varying Markov model comprising three states to assess the cost and effectiveness of PR added to guideline-directed medical treatment (GDMT) compared with GDMT alone. Clinical outcomes considered within the model were overall survival and heart failure (HF) hospitalisations (HFH), and the incremental cost-effectiveness ratio (ICER) was calculated. Cost data were derived from a literature search. Sensitivity analyses were undertaken.Setting The French healthcare system perspective assuming a lifetime horizon.Participants Published data at 5 years obtained from patients enrolled in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation study.Results In our base case, we chose cubic spline models to extrapolate overall survival, and we used log-logistic models to estimate cumulative HFH. After discounting, the model generated life-years of 3.843 years and 3.055 years for PR+GDMT and GDMT, respectively. Discounted total quality-adjusted life-year (QALY) values were 2.572 and 1.945 for PR+GDMT and GDMT, respectively (incremental 0.627 QALY). Discounted total costs were €42 709 and €20 732 for the intervention and the control groups, respectively (incremental €21,977), resulting in an ICER of €35,068/QALY. At a threshold of €50 000 per QALY, PR had a 0.85 probability of being cost-effective.Conclusion Updated trial data have enabled investigators to provide a more reliable estimation of the ICER, which suggests that PR has good value for money compared with GDMT alone. |
| format | Article |
| id | doaj-art-ffb4e5086b14451d9c0e6fddaaba54ee |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-ffb4e5086b14451d9c0e6fddaaba54ee2025-08-20T02:49:39ZengBMJ Publishing GroupBMJ Open2044-60552024-12-01141210.1136/bmjopen-2024-087695Cost-effectiveness of percutaneous mitral repair for patients with severe secondary mitral regurgitation: an updated evaluation using a modelling approach based on COAPT final data after 5-year follow-upXavier Armoiry0Peter Auguste1Martin Connock2Jean-Francois Obadia3Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, FranceUniversity of Warwick Warwick Medical School, Coventry, UKDivision of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UKClaude Bernard University, Lyon, FranceObjectives To evaluate the cost-effectiveness of percutaneous repair (PR) for secondary mitral regurgitation.Design An economic evaluation using a time-varying Markov model comprising three states to assess the cost and effectiveness of PR added to guideline-directed medical treatment (GDMT) compared with GDMT alone. Clinical outcomes considered within the model were overall survival and heart failure (HF) hospitalisations (HFH), and the incremental cost-effectiveness ratio (ICER) was calculated. Cost data were derived from a literature search. Sensitivity analyses were undertaken.Setting The French healthcare system perspective assuming a lifetime horizon.Participants Published data at 5 years obtained from patients enrolled in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation study.Results In our base case, we chose cubic spline models to extrapolate overall survival, and we used log-logistic models to estimate cumulative HFH. After discounting, the model generated life-years of 3.843 years and 3.055 years for PR+GDMT and GDMT, respectively. Discounted total quality-adjusted life-year (QALY) values were 2.572 and 1.945 for PR+GDMT and GDMT, respectively (incremental 0.627 QALY). Discounted total costs were €42 709 and €20 732 for the intervention and the control groups, respectively (incremental €21,977), resulting in an ICER of €35,068/QALY. At a threshold of €50 000 per QALY, PR had a 0.85 probability of being cost-effective.Conclusion Updated trial data have enabled investigators to provide a more reliable estimation of the ICER, which suggests that PR has good value for money compared with GDMT alone.https://bmjopen.bmj.com/content/14/12/e087695.full |
| spellingShingle | Xavier Armoiry Peter Auguste Martin Connock Jean-Francois Obadia Cost-effectiveness of percutaneous mitral repair for patients with severe secondary mitral regurgitation: an updated evaluation using a modelling approach based on COAPT final data after 5-year follow-up BMJ Open |
| title | Cost-effectiveness of percutaneous mitral repair for patients with severe secondary mitral regurgitation: an updated evaluation using a modelling approach based on COAPT final data after 5-year follow-up |
| title_full | Cost-effectiveness of percutaneous mitral repair for patients with severe secondary mitral regurgitation: an updated evaluation using a modelling approach based on COAPT final data after 5-year follow-up |
| title_fullStr | Cost-effectiveness of percutaneous mitral repair for patients with severe secondary mitral regurgitation: an updated evaluation using a modelling approach based on COAPT final data after 5-year follow-up |
| title_full_unstemmed | Cost-effectiveness of percutaneous mitral repair for patients with severe secondary mitral regurgitation: an updated evaluation using a modelling approach based on COAPT final data after 5-year follow-up |
| title_short | Cost-effectiveness of percutaneous mitral repair for patients with severe secondary mitral regurgitation: an updated evaluation using a modelling approach based on COAPT final data after 5-year follow-up |
| title_sort | cost effectiveness of percutaneous mitral repair for patients with severe secondary mitral regurgitation an updated evaluation using a modelling approach based on coapt final data after 5 year follow up |
| url | https://bmjopen.bmj.com/content/14/12/e087695.full |
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