Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings

To determine the cost-effectiveness of the percutaneous mitral valve repair (PMVR) using Carillon® Mitral Contour System® (Cardiac Dimensions Inc., Kirkland, WA, USA) in patients with congestive heart failure accompanied by moderate to severe functional mitral regurgitation (FMR) compared to the pro...

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Bibliographic Details
Published in:	BMC cardiovascular disorders Vol. 15; no. 1; p. 43
Main Authors:	Borisenko, Oleg, Haude, Michael, Hoppe, Uta C, Siminiak, Tomasz, Lipiecki, Janusz, Goldberg, Steve L, Mehta, Nawzer, Bouknight, Omari V, Bjessmo, Staffan, Reuter, David G
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 14-05-2015 BioMed Central
Subjects:	Analysis Comparative analysis Cost-Benefit Analysis Decision Trees Economic aspects Epidemiology Female Germany Heart Failure - complications Heart Valve Prosthesis Implantation - economics Heart Valve Prosthesis Implantation - instrumentation Heart Valve Prosthesis Implantation - methods Humans Male Markov Chains Medicin och hälsovetenskap Middle Aged Mitral Valve Annuloplasty - economics Mitral Valve Annuloplasty - methods Mitral Valve Insufficiency - complications Mitral Valve Insufficiency - physiopathology Mitral Valve Insufficiency - surgery Quality-Adjusted Life Years Sensitivity and Specificity Germany
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Summary:	To determine the cost-effectiveness of the percutaneous mitral valve repair (PMVR) using Carillon® Mitral Contour System® (Cardiac Dimensions Inc., Kirkland, WA, USA) in patients with congestive heart failure accompanied by moderate to severe functional mitral regurgitation (FMR) compared to the prolongation of optimal medical treatment (OMT). Cost-utility analysis using a combination of a decision tree and Markov process was performed. The clinical effectiveness was determined based on the results of the Transcatheter Implantation of Carillon Mitral Annuloplasty Device (TITAN) trial. The mean age of the target population was 62 years, 77% of the patients were males, 64% of the patients had severe FMR and all patients had New York Heart Association functional class III. The epidemiological, cost and utility data were derived from the literature. The analysis was performed from the German statutory health insurance perspective over 10-year time horizon. Over 10 years, the total cost was €36,785 in the PMVR arm and €18,944 in the OMT arm. However, PMVR provided additional benefits to patients with an 1.15 incremental quality-adjusted life years (QALY) and an 1.41 incremental life years. The percutaneous procedure was cost-effective in comparison to OMT with an incremental cost-effectiveness ratio of €15,533/QALY. Results were robust in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis with a willingness-to-pay threshold of €35,000/QALY, PMVR had a 84 % probability of being cost-effective. Percutaneous mitral valve repair may be cost-effective in inoperable patients with FMR due to heart failure.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1471-2261 1471-2261
DOI:	10.1186/s12872-015-0039-8