Cost-effectiveness of the MitraClip device in German heart failure patients with secondary mitral regurgitation

Estler, Bent; Rudolph, Volker; Seleznova, Yana; Shukri, Arim; Stock, Stephanie; Müller, D.

doi:10.1007/s10198-022-01476-4

Cited by 9 publications

(19 citation statements)

References 26 publications

(51 reference statements)

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“…Due to the differences in economic development between various countries or regions, the WTP threshold varies a lot in different countries, especially between developed countries and developing counties. The WTP threshold in China is 242,928 CNY/QALY, equal to 37,655 US$/QALY, and the value is 5,089 US$/QALY in Thailand ( 27 ), 45,500 in Japan ( 38 ), 79,241 in Germany ( 39 ), and 100,000 in the USA ( 40 ). Given the differences in WTP among countries, the price of sacubitril-valsartan varies among countries.…”

Section: Discussionmentioning

confidence: 99%

Sacubitril-valsartan for the treatment of hypertension in China: A cost-utility analysis based on meta-analysis of randomized controlled trials

Lou

Liu²,

Huang³

2022

Front. Public Health

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BackgroundSacubitril-valsartan was recommended for heart failure (HF) and proven cost-effective in HF. Recently, sacubitril-valsartan has been recommended to treat hypertension by the Chinese expert consensus. The cost utility of sacubitril-valsartan for hypertension remains uninvestigated.MethodsA meta-analysis of randomized controlled trials (RCTs) was performed to investigate the real efficacy of sacubitril-valsartan on blood pressure, compared with angiotensin receptor blockers or placebo. A lifetime Markov model was developed to compare the cost utility of sacubitril-valsartan vs. valsartan. The primary outcome was the incremental cost-utility ratio (ICUR), representing the ratio of incremental costs to the incremental utility. The willingness-to-pay (WTP) threshold was three times of per capita gross domestic product (GDP) in China in 2021. Sacubitril-valsartan was considered cost-effective if the ICUR obtained was lower than the WTP threshold, otherwise, sacubitril-valsartanis was not cost-effective.ResultsA total of 10 RCTs of 5,781 patients were included in the meta-analysis. For comparison of sacubitril-valsartan 400 mg/day vs. valsartan 320 mg/day, a reduction in blood pressure (BP) of −5.97 (−6.38, −5.56) (p < 0.01) was observed. Cost-utility analysis showed that for a 60-year-old patient with hypertension, if sacubitril-valsartan was prescribed as the antihypertensive agent, he had a life expectancy of 11.91 quality-adjusted life-years (QALYs) with costs of 65,066 CNY, and if valsartan was prescribed as the antihypertensive agent, the life expectancy would be 11.82 QALY with costs of 54,769 CNY; thus, an ICUR of 108,622 CNY/QALY was obtained, lower than the WTP threshold.ConclusionCompared with valsartan, sacubitril-valsartan is more effective in reducing blood pressure and may result in more quality-adjusted life-year, although with higher costs. Sacubitril-valsartan is cost-effective for hypertension in the current China setting under the willingness-to-pay threshold of 3 times of per capita GDP.

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Section: Discussionmentioning

confidence: 99%

Sacubitril-valsartan for the treatment of hypertension in China: A cost-utility analysis based on meta-analysis of randomized controlled trials

Lou

Liu²,

Huang³

2022

Front. Public Health

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“…First, the cost of overall MitraClip in China is higher than in other regions. According to our search of published articles, the cost of a MitraClip device ranged from 143,951 to 247,478 CNY in different countries (10,16), but the price in China is 322,000 CNY, which is about twice the price abroad. Moreover, there is not so much difference in other MitraClip-related costs in China and other countries.…”

Section: Discussionmentioning

confidence: 99%

“…A halfcycle correction was employed in the Markov model to prevent the overestimation of effectiveness and cost. The details of the model are illustrated in Figure 1, which has been validated by another study (10).…”

Section: Model Overviewmentioning

confidence: 99%

“…The 30-day outcome was directly extracted from the COAPT trial, and the transition probability in the Markov model was transformed from the COAPT trial to better represent the real efficacy of MitraClip vs. OMT. The transition probability in the COAPT trial was not reported in the published paper, but it was calculated by Estler et al (10). The transition probability between NYHA classifications is presented in Table 1.…”

Section: Input Parameters Transition Probabilitymentioning

confidence: 99%

“…The utility of MitraClip-related cost was derived from a study of cost-effectiveness analysis, which reported that the one-month disutility for the MitraClip procedure was −0.043 (10,19). The utility of different NYHA classifications was obtained from a study of the Chinese population (17).…”

Section: Utilitymentioning

confidence: 99%

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MitraClip for the treatment of heart failure with mitral regurgitation: A cost-effectiveness analysis in a Chinese setting

Xia

Han

Lou

2022

Front. Cardiovasc. Med.

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BackgroundHeart failure (HF) with mitral regurgitation is associated with decreased survival. Guideline-directed medical therapy and transcatheter edge-to-edge repair (TEER) are the main options for HF patients with severe mitral regurgitation who are considered high-risk or prohibitive. To date, there have been no studies investigating the cost-effectiveness of MitraClip vs. optimal medical therapy (OMT) in a Chinese setting.MethodsA combined decision tree and Markov model were developed to compare the cost-effectiveness MitraClip vs. OMT with a lifetime simulation. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represented incremental costs per quality-adjusted life-year (QALY). The willingness-to-pay (WTP) threshold was set three times of per capita gross domestic product (GDP) in China in 2021, which was 242,928 CNY. MitraClip would be considered cost-effective if the ICER obtained was lower than the WTP threshold. Otherwise, it would be not considered cost-effective. One-way sensitivity and probabilistic sensitivity analyses were performed to validate the robustness of the results.ResultsAfter a simulation of the lifetime, the overall cost for a patient in the MitraClip cohort was 423,817 CNY, and the lifetime cost in the OMT was 28,369 CNY. The corresponding effectiveness in both cohorts was 2.32 QALY and 1.80 QALY per person, respectively. The incremental cost and increment effectiveness were 395,448 CNY and 0.52 QALY, respectively, and the ICER was 754,410 CNY/QALY. The ICER obtained was higher than the WTP threshold. Sensitivity analysis validated our finding.ConclusionMitraClip provided effectiveness but with more costs compared with OMT, and the incremental cost-effectiveness ratio obtained was higher than the WTP threshold. MitraClip was considered not cost-effective in Chinese HF patients with secondary mitral regurgitation.

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Long‐term cost‐effectiveness of transcatheter mitral valve repair in HF patients with secondary mitral regurgitation

Yao,

Zhou,

Geng

et al. 2024

ESC Heart Failure

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AimsThe long‐term cost‐effectiveness of MitraClip in heart failure patients with secondary mitral regurgitation is still unclear. This study aimed to evaluate the long‐term cost‐effectiveness of MitraClip added to guideline‐directed medical therapy vs. guideline‐directed medical therapy alone in heart failure patients with secondary mitral regurgitation from the perspective of the healthcare systems of mainland China, the United Kingdom, Germany, and the United States.Methods and resultsA two‐stage (decision + Markov) model was built. Health utilities were defined by the New York Heart Association class, heart failure re‐hospitalization, and death and were calculated based on the 5 year follow‐up results of the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation trial. Direct healthcare costs were derived from the nationally representative data. Future utilities and costs were discounted at country‐specific rates. The primary outcome was the lifetime incremental cost‐effectiveness ratio. The mean age of the base case in our model was 72.2 years. Over a lifetime horizon, treatment with MitraClip was associated with 829 fewer heart failure re‐hospitalizations per 1000 treated patients. The MitraClip treatment was associated with incremental quality‐adjusted life‐year gains of 0.71, 0.76, 0.78, and 0.78, as well as incremental cost‐effectiveness ratios of ¥468 462, £28 910, €26 045, and $71 199 per quality‐adjusted life‐year for a lifetime horizon in mainland China, the United Kingdom, Germany, and the United States, respectively. In probabilistic sensitivity analysis, 0.2%, 59.4%, 99.6%, and 84.7% of patients were cost‐effective in mainland China, the United Kingdom, Germany, and the United States at the country‐specific willingness‐to‐pay thresholds.ConclusionsMitraClip + guideline‐directed medical therapy was cost‐effective in heart failure patients with secondary mitral regurgitation in the United Kingdom, Germany, and the United States, but not in mainland China from the perspective of the national healthcare system.

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Cost-effectiveness of the MitraClip device in German heart failure patients with secondary mitral regurgitation

Cited by 9 publications

References 26 publications

Sacubitril-valsartan for the treatment of hypertension in China: A cost-utility analysis based on meta-analysis of randomized controlled trials

Sacubitril-valsartan for the treatment of hypertension in China: A cost-utility analysis based on meta-analysis of randomized controlled trials

MitraClip for the treatment of heart failure with mitral regurgitation: A cost-effectiveness analysis in a Chinese setting

Long‐term cost‐effectiveness of transcatheter mitral valve repair in HF patients with secondary mitral regurgitation

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