Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation

Cardiothoracic Surgical Trials Network Investigators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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. 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. Results: In-hospital costs were $59,745 for coronary artery bypass grafting plus mitral valve repair versus $51,326 for coronary artery bypass grafting alone (difference $8419; 95% uncertainty interval, 2259-18,757). Two-year costs were $81,263 versus $67,341 (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 $308,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ($107,733 vs $88,583, 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 $100K/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 $100K/quality-adjusted life year. 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.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Mitral Valve Insufficiency
Quality-Adjusted Life Years
Mitral Valve
Coronary Artery Bypass
Cost-Benefit Analysis
Costs and Cost Analysis
Uncertainty
Hospitalization
Ventricular Remodeling
Survival
Mortality
Hospital Costs
Health Resources
Quality of Life

Keywords

  • CABG
  • Cardiothoracic Surgical Trials Network
  • cost-effectiveness analysis
  • health care costs
  • ischemic mitral regurgitation
  • mitral valve
  • mitral valve repair
  • quality-adjusted life years

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{48ac52976bc346af972e532128f916b9,
title = "Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation",
abstract = "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. 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. Results: In-hospital costs were $59,745 for coronary artery bypass grafting plus mitral valve repair versus $51,326 for coronary artery bypass grafting alone (difference $8419; 95{\%} uncertainty interval, 2259-18,757). Two-year costs were $81,263 versus $67,341 (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 $308,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ($107,733 vs $88,583, 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 $100K/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 $100K/quality-adjusted life year. 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.",
keywords = "CABG, Cardiothoracic Surgical Trials Network, cost-effectiveness analysis, health care costs, ischemic mitral regurgitation, mitral valve, mitral valve repair, quality-adjusted life years",
author = "{Cardiothoracic Surgical Trials Network Investigators} and Ferket, {Bart S.} and Thourani, {Vinod H.} and Pierre Voisine and Hohmann, {Samuel F.} and Chang, {Helena L.} and Smith, {Peter K.} and Michler, {Robert E.} and Gorav Ailawadi and Perrault, {Louis P.} and Miller, {Marissa A.} and Karen O'Sullivan and Mick, {Stephanie L.} and Emilia Bagiella and Acker, {Michael A.} and Ellen Moquete and Hung, {Judy W.} and Overbey, {Jessica R.} and Anuradha Lala and Margaret Iraola and Gammie, {James S.} and Gelijns, {Annetine C.} and O'Gara, {Patrick T.} and Moskowitz, {Alan J.} and Taddei-Peters, {Wendy C.} and Dennis Buxton and Ron Caulder and Geller, {Nancy L.} and David Gordon and Jeffries, {Neal O.} and Albert Lee and Moy, {Claudia S.} and Gombos, {Ilana Kogan} and Jennifer Ralph and Richard Weisel and Gardner, {Timothy J.} and Rose, {Eric A.} and Parides, {Michael K.} and Ascheim, {Deborah D.} and Helena Chang and Melissa Chase and Yingchun Chen and Seth Goldfarb and Lopa Gupta and Katherine Kirkwood and Edlira Dobrev and DeRose, {Joseph J.} and Goldstein, {Daniel J.} and William Jakobleff and Mario Garcia and Cynthia Taub",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jtcvs.2019.06.040",
language = "English (US)",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation

AU - Cardiothoracic Surgical Trials Network Investigators

AU - Ferket, Bart S.

AU - Thourani, Vinod H.

AU - Voisine, Pierre

AU - Hohmann, Samuel F.

AU - Chang, Helena L.

AU - Smith, Peter K.

AU - Michler, Robert E.

AU - Ailawadi, Gorav

AU - Perrault, Louis P.

AU - Miller, Marissa A.

AU - O'Sullivan, Karen

AU - Mick, Stephanie L.

AU - Bagiella, Emilia

AU - Acker, Michael A.

AU - Moquete, Ellen

AU - Hung, Judy W.

AU - Overbey, Jessica R.

AU - Lala, Anuradha

AU - Iraola, Margaret

AU - Gammie, James S.

AU - Gelijns, Annetine C.

AU - O'Gara, Patrick T.

AU - Moskowitz, Alan J.

AU - Taddei-Peters, Wendy C.

AU - Buxton, Dennis

AU - Caulder, Ron

AU - Geller, Nancy L.

AU - Gordon, David

AU - Jeffries, Neal O.

AU - Lee, Albert

AU - Moy, Claudia S.

AU - Gombos, Ilana Kogan

AU - Ralph, Jennifer

AU - Weisel, Richard

AU - Gardner, Timothy J.

AU - Rose, Eric A.

AU - Parides, Michael K.

AU - Ascheim, Deborah D.

AU - Chang, Helena

AU - Chase, Melissa

AU - Chen, Yingchun

AU - Goldfarb, Seth

AU - Gupta, Lopa

AU - Kirkwood, Katherine

AU - Dobrev, Edlira

AU - DeRose, Joseph J.

AU - Goldstein, Daniel J.

AU - Jakobleff, William

AU - Garcia, Mario

AU - Taub, Cynthia

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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. 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. Results: In-hospital costs were $59,745 for coronary artery bypass grafting plus mitral valve repair versus $51,326 for coronary artery bypass grafting alone (difference $8419; 95% uncertainty interval, 2259-18,757). Two-year costs were $81,263 versus $67,341 (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 $308,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ($107,733 vs $88,583, 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 $100K/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 $100K/quality-adjusted life year. 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.

AB - 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. 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. Results: In-hospital costs were $59,745 for coronary artery bypass grafting plus mitral valve repair versus $51,326 for coronary artery bypass grafting alone (difference $8419; 95% uncertainty interval, 2259-18,757). Two-year costs were $81,263 versus $67,341 (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 $308,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ($107,733 vs $88,583, 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 $100K/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 $100K/quality-adjusted life year. 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.

KW - CABG

KW - Cardiothoracic Surgical Trials Network

KW - cost-effectiveness analysis

KW - health care costs

KW - ischemic mitral regurgitation

KW - mitral valve

KW - mitral valve repair

KW - quality-adjusted life years

UR - http://www.scopus.com/inward/record.url?scp=85069878953&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069878953&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2019.06.040

DO - 10.1016/j.jtcvs.2019.06.040

M3 - Article

AN - SCOPUS:85069878953

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

ER -