Cost-Effectiveness of Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement for Degenerated Bioprosthetic Mitral Valve.

BACKGROUND

Degenerated bioprosthetic mitral valves (MVs) are associated with significant morbidity and health care expenditures. For certain patients, valve-in-valve transcatheter MV replacement (ViV TMVR) has emerged as a promising treatment option due to fewer complications and shorter hospital length of stay when compared with redo surgical MV replacement (redo-SMVR). We constructed a decision-analytic model comparing the cost-effectiveness of ViV TMVR to redo-SMVR for the management of degenerated bioprosthetic valves.

METHODS

Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. The main outcome was ICERs defined as United States (US) dollars/deaths averted.

RESULTS

In the base case analysis, the cost associated with ViV TMVR was estimated at $87,724 with a 0.93 probability of survival at 1 month. For the redo-SMVR strategy, the cost was $104,444, and the probability of survival at 1 month was 0.89. Overall, ViV TMVR resulted in savings of $418,001 per death averted (ICER, -$418,001/death averted). In cost-effectiveness acceptability curves, ViV TMVR was cost-effective in 83% to 88% of simulations for a willingness-to-pay threshold ranging from $0 to $100,000.

CONCLUSIONS

ViV TMVR is an effective strategy that may result in significant health care savings for the management of degenerated bioprosthetic valves.