Pulse Brain · Growing Health Evidence Index
Tier 2 — RCT / large cohortPeer-reviewed

Cost-Effectiveness of Mitral Valve Repair Versus Replacement for Severe Ischemic Mitral Regurgitation

Bart S. Ferket, Gorav Ailawadi, Annetine C. Gelijns, Michael A. Acker, Samuel F. Hohmann, Helena Chang, Denis Bouchard, David O. Meltzer, Robert E. Michler, Ellen Moquete, Pierre Voisine, John C. Mullen, Anuradha Lala, Michael J. Mack, A. Marc Gillinov, Vinod H. Thourani, Marissa A. Miller, James S. Gammie, Michael K. Parides, Emilia Bagiella, Robert L. Smith, Peter K. Smith, Judy Hung, Lopa Gupta, Eric A. Rose, Patrick T. O’Gara, Alan J. Moskowitz, for the Cardiothoracic Surgical Trials Network (CTSN) Investigators*, Wendy C. Taddei‐Peters, Dennis Buxton, Nancy L. Geller, David F. Gordon, Neal Jeffries, Albert Lee, Claudia S. Moy, Ilana Kogan Gombos, Jennifer Ralph, Richard D. Weisel, Timothy J. Gardner, Deborah D. Ascheim, Ellen Moquete, Helena Chang, Melissa Chase, James Foo, Lopa Gupta, Katherine Kirkwood, Edlira Dobrev, Ron Levitan, Karen O’Sullivan, Jessica Overbey, Milerva Santos, Deborah Williams, Paula Williams, Xia Ye, Michael J. Mack, Tracine Adame, Natalie Settele, Jenny Adams, William H. Ryan, Paul Grayburn, Frederick Y. Chen, Anju Nohria, Lawrence Cohn, Prem Shekar, Sary F. Aranki, Gregory Couper, Michael Davidson, R. Morton Bolman, Rita Lawrence, Eugene H. Blackstone, Carrie Geither, Leoma Berroteran, Diana Dolney, Kristen Doud, Suzanne Fleming, Roberta Palumbo, Christine Whitman, Kathy Sankovic, Denise Kosty Sweeney, Gregory Pattakos, Pamela A.G. Clarke, Michael Argenziano, Mathew Williams, Lyn Goldsmith, Craig R. Smith, Yoshifumi Naka, Allan Stewart, Allan Schwartz, Daniel Bell, Danielle Van Patten, Sowmyashree Sreekanth, John H. Alexander, Carmelo A. Milano, Donald D. Glower, Joseph P. Mathew, J. Kevin Harrison, Stacey Welsh, Mark F. Berry, Cyrus J. Parsa, Betty C. Tong

Circulation Cardiovascular Quality and Outcomes · 2018

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Summary

This cost-effectiveness analysis of the CTSN randomised controlled trial compared mitral valve repair versus replacement for severe ischemic mitral regurgitation in 251 patients. Over the 2-year trial period, repair and replacement showed similar costs and QALYs with minimal differences; however, replacement demonstrated more durable correction of mitral regurgitation and fewer cardiovascular readmissions. At 10 years, replacement showed a small and uncertain cost-effectiveness advantage over repair, with marginal improvements in both survival and QALYs.

Regional applicability

This study was conducted in United States healthcare settings and reflects US hospital cost structures and clinical practices. The findings may have limited direct applicability to United Kingdom NHS provision, given differences in healthcare economics, treatment pathways, and cost models, though the comparative clinical outcomes (durability of repair versus replacement) may inform international practice consideration.

Key measures

In-hospital costs, 2-year cumulative costs, quality-adjusted life years (QALYs), cardiovascular readmission rates, survival, incremental cost-effectiveness ratios

Outcomes reported

The study compared costs, quality-adjusted life years (QALYs), readmission rates, and survival between mitral valve repair and replacement for severe ischemic mitral regurgitation over 2, 5, and 10-year time horizons.

Theme
General food systems / other
Subject
Other / interdisciplinary
Study type
Research
Study design
RCT with cost-effectiveness analysis and microsimulation
Source type
Peer-reviewed study
Status
Published
Geography
United States
System type
Human clinical
DOI
10.1161/circoutcomes.117.004466
Catalogue ID
BFmowc2cfp-d1uu1z

Topic tags

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