Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation.
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
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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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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