Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation.

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Citation: Journal of Thoracic & Cardiovascular Surgery. 159(6):2230-2240.e15, 2020 06.PMID: 31375378Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Coronary Artery Bypass/ec [Economics] | *Coronary Artery Disease/ec [Economics] | *Coronary Artery Disease/su [Surgery] | *Heart Valve Prosthesis Implantation/ec [Economics] | *Hospital Costs | *Mitral Valve Annuloplasty/ec [Economics] | *Mitral Valve Insufficiency/ec [Economics] | *Mitral Valve Insufficiency/su [Surgery] | Aged | Canada | Computer Simulation | Coronary Artery Bypass/ae [Adverse Effects] | Coronary Artery Disease/co [Complications] | Coronary Artery Disease/dg [Diagnostic Imaging] | Cost-Benefit Analysis | Female | Heart Valve Prosthesis Implantation/ae [Adverse Effects] | Humans | Male | Middle Aged | Mitral Valve Annuloplasty/ae [Adverse Effects] | Mitral Valve Insufficiency/dg [Diagnostic Imaging] | Mitral Valve Insufficiency/et [Etiology] | Models, Economic | Multicenter Studies as Topic | Quality of Life | Quality-Adjusted Life Years | Randomized Controlled Trials as Topic | Risk Factors | Time Factors | Treatment OutcomeYear: 2020Local holdings: Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0022-5223
Name of journal: The Journal of thoracic and cardiovascular surgeryAbstract: CONCLUSIONS: The addition of mitral valve repair to coronary artery bypass grafting for patients with moderate ischemic mitral regurgitation is unlikely to be cost-effective. Only if late mortality benefits can be demonstrated will it meet commonly used cost-effectiveness criteria.Copyright (c) 2019. Published by Elsevier Inc.METHODS: We used individual patient data from the Cardiothoracic Surgical Trials Network trial on survival, hospitalizations, quality of life, and US hospitalization costs to estimate cumulative costs and quality-adjusted life years. A microsimulation model was developed to extrapolate to 10 years. Bootstrap and deterministic sensitivity analyses were performed to address uncertainty.OBJECTIVE: The Cardiothoracic Surgical Trials Network reported that left ventricular reverse remodeling at 2 years did not differ between patients with moderate ischemic mitral regurgitation randomized to coronary artery bypass grafting plus mitral valve repair (n = 150) or coronary artery bypass grafting alone (n = 151). To address health resource use implications, we compared costs and quality-adjusted survival.RESULTS: In-hospital costs were All authors: Acker MA, Ailawadi G, Bagiella E, Cardiothoracic Surgical Trials Network Investigators, Chang HL, Ferket BS, Gammie JS, Gelijns AC, Hohmann SF, Hung JW, Iraola M, Lala A, Michler RE, Mick SL, Miller MA, Moquete E, Moskowitz AJ, O'Gara PT, O'Sullivan K, Overbey JR, Perrault LP, Smith PK, Thourani VH, Voisine POriginally published: Journal of Thoracic & Cardiovascular Surgery. 2019 Jul 02Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-08-23
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Journal Article MedStar Authors Catalog Article 31375378 Available 31375378

Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSIONS: The addition of mitral valve repair to coronary artery bypass grafting for patients with moderate ischemic mitral regurgitation is unlikely to be cost-effective. Only if late mortality benefits can be demonstrated will it meet commonly used cost-effectiveness criteria.

Copyright (c) 2019. Published by Elsevier Inc.

METHODS: We used individual patient data from the Cardiothoracic Surgical Trials Network trial on survival, hospitalizations, quality of life, and US hospitalization costs to estimate cumulative costs and quality-adjusted life years. A microsimulation model was developed to extrapolate to 10 years. Bootstrap and deterministic sensitivity analyses were performed to address uncertainty.

OBJECTIVE: The Cardiothoracic Surgical Trials Network reported that left ventricular reverse remodeling at 2 years did not differ between patients with moderate ischemic mitral regurgitation randomized to coronary artery bypass grafting plus mitral valve repair (n = 150) or coronary artery bypass grafting alone (n = 151). To address health resource use implications, we compared costs and quality-adjusted survival.

RESULTS: In-hospital costs were 9,745 for coronary artery bypass grafting plus mitral valve repair versus 1,326 for coronary artery bypass grafting alone (difference 419; 95% uncertainty interval, 2259-18,757). Two-year costs were 1,263 versus 7,341 (difference 13,922 [2370 to 28,888]), and quality-adjusted life years were 1.35 versus 1.30 (difference 0.05; -0.04 to 0.14), resulting in an incremental cost-effectiveness ratio of 08,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ( 07,733 vs 8,583, difference 19,150 [-3866 to 56,826]) and quality-adjusted life years showed no difference (-0.92 to 0.87), with 5.08 versus 5.08. The likelihood that coronary artery bypass grafting plus mitral valve repair would be considered cost-effective at 10 years based on a cost-effectiveness threshold of 00K/quality-adjusted life year did not exceed 37%. Only when this procedure reduces the death rate by a relative 5% will the incremental cost-effectiveness ratio fall below 00K/quality-adjusted life year.

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