Cost-effectiveness analysis of mitral valve repair with the MitraClip delivery system for patients with mitral regurgita
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Cost‑effectiveness analysis of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation: a systematic review Aziz Rezapour1 · Samad Azari1,2 · Jalal Arabloo1 · Hamid Pourasghari2 · Masoud Behzadifar3 · Vahid Alipour1 · Negar Omidi4 · Saeed Sadeghian5 · Hassan Aghajani5 · Nicola Luigi Bragazzi6 Accepted: 9 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract To assess the cost-effectiveness of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation and heart failure, a systematic literature search was conducted in various electronic databases to January 3, 2020. Eligibility criteria are the population (patients with mitral regurgitation (MR)), intervention (transcatheter mitral valve repair using the MitraClip), comparator (conventional medical treatment), outcomes, and designs (Model-based or trial-based full economic evaluations).The quality of included studies was assessed using the CHEERS checklist. Mortality and survival rate, qualityadjusted life year (QALY), life years gained (LYG), total cost, and the incremental cost-effectiveness ratio (ICER) regarding the use of MitraClip System were considered as the key outcomes. Eight articles were eligible for full-text assessment. Ultimately, a total of seven studies were considered in the current systematic review. Results demonstrated that MitraClip reduces mortality rate and increases survival rate. The mortality rate at 1 year and 10 years was 16.7% versus 29.77% and 70.9% versus 98.8%, respectively. Total cost data based on 2019 USD show that the MitraClip has the highest cost in the USA ($121,390) and the lowest cost in Italy ($33,062). The results showed that in all selected countries, willingness-to-pay (WTP) thresholds are upper than the cost per QALY; also, the highest ICER for the MitraClip is in the USA ($55,600/QALY) and the lowest in Italy ($10,616/QALY). To conclude, evidence from this systematic review suggests that MitraClip Delivery System improved both life expectancy and QALY compared with medical treatment in patients at high surgical risk and it was also a cost-effective treatment option for patients with mitral regurgitation. Keywords Cost-effectiveness · Mitral valve repair · Mitral regurgitation · MitraClip · Systematic review
Introduction Valve heart diseases (VHD) represent a serious public health concern, with an age- and sex-corrected prevalence rate of 2.5%, according to a recent populationbased study [1]. Among VHD, mitral valve regurgitation (MVR), occurring when blood flows back through during the closure of the leaflets and the left ventricle contraction, is the most common VHD globally, in that it affects approximately up to 4 million people in the USA alone. Its prevalence rate increases with age and it is expected to increase further due to the aging of the * Samad Azari [email protected]
population [2, 3]. Although declining in the Western population, mitral stenosis (MS) is still a frequent disease in the
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