Clinical outcomes and economic impact of transcatheter mitral leaflet repair in heart failure patients
| Autor: | Raoul Bonan, Anita W. Asgar, David J. Cohen, Arsène Basmadjian, Paul Khairy, Anique Ducharme, Daniel Cournoyer, Jean-Claude Tardif, Marie-Claude Guertin |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
Canada medicine.medical_specialty Cost effectiveness Cost-Benefit Analysis 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine Mitral valve Humans Medicine Prospective Studies cardiovascular diseases 030212 general & internal medicine Prospective cohort study Aged Heart Failure Heart Valve Prosthesis Implantation Mitral regurgitation business.industry Health Policy MitraClip Health Care Costs Middle Aged medicine.disease Surgery Models Economic Treatment Outcome medicine.anatomical_structure Heart failure Cohort cardiovascular system Cardiology Health Resources Mitral Valve Female Observational study Quality-Adjusted Life Years business |
| Zdroj: | Journal of Medical Economics. 20:82-90 |
| ISSN: | 1941-837X 1369-6998 |
| Popis: | Background: Mitral regurgitation (MR) is a common valvular heart disorder requiring intervention once it becomes severe. Transcatheter mitral repair with the MitraClip device is a safe and effective therapy for selected patients denied surgery. The authors sought to evaluate the clinical outcomes and economic impact of this therapy compared to medical management in heart-failure patients with symptomatic mitral regurgitation. Methods and results: The study was comprised of two phases; an observational study of patients with heart failure and mitral regurgitation treated with either medical therapy or the MitraClip, and an economic model. Results of the observational study were used to estimate parameters for the decision model, which estimated costs, and benefits in a hypothetical cohort of patients with heart failure and moderate-to-severe mitral regurgitation treated with either standard medical therapy or MitraClip. The cohort of patients treated with the MitraClip was propensity matched to a population of heart failure patients, and their outcomes compared. At a mean follow-up of 22 months, all-cause mortality was 21% in the MitraClip cohort and 42% in the medical management cohort (p = .007). The decision model demonstrated that MitraClip increased life expectancy from 1.87–3.60 years and quality-adjusted life years (QALY) from 1.13–2.76 years. The incremental cost was $52,500 Canadian dollars, corresponding to an incremental cost-effectiveness ratio (ICER) of $32,300.00 per QALY gained. Results were sensitive to the survival benefit. Conclusion: In heart failure patients with symptomatic moderate–severe mitral regurgitation, therapy with the MitraClip is associated with superior survival and is cost-effective compared to medical therapy. |
| Databáze: | OpenAIRE |
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