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

Abstract

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.

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

“…8 Thus, there was a potentially large bias about the long-term cost-effectiveness evaluation in previous studies. [10][11][12][13] Although the use of MitraClip was associated with less HF re-hospitalization and death, which contributed to more QALYs gained and important cost savings during follow-up, our study showed that the cost-effectiveness of MitraClip was different across countries. The base-case analyses for three developed countries (the United Kingdom, Germany, and the United States) indicated that MitraClip + GDMT was cost-effective for HF patients with moderate-to-severe or severe secondary MR compared with GDMT alone, and both the one-way sensitivity analysis and the PSA showed that most results were robust.…”

“…To the best of our knowledge, our study is the first to evaluate the long-term cost-effectiveness of the MitraClip treatment based on the 5 year follow-up result of the COAPT trial. By using NYHA classes at a series of time points during a 5 year follow-up to calculate health utility instead of NYHA transition probabilities as reported in previous studies, [12][13][14][15] our study makes the estimation of health utility more precise because NYHA transition probabilities may not be uniformly distributed. A study reported by Baron et al estimated that the 5 year probability of all-cause death was 51.8% in the MitraClip group and 68.3% in the GDMT group.…”

“…Such differences indicated that the estimation of mortality was underestimated not only in the MitraClip group but also in the GDMT group because the mitral transcatheter edge‐to‐edge repair was performed in 62 patients, representing 44.9% of the 138 patients after 2 years 8 . Thus, there was a potentially large bias about the long‐term cost‐effectiveness evaluation in previous studies 10–13 …”

“…After a 5 year simulation, survivors would enter a Markov model to explore the long‐term effects of different treatments. A lifetime horizon with a cycle length of 1 year was applied in the Markov model, consistent with previous HF economic studies 10–15 . Patients would experience HF re‐hospitalization, death, or no adverse events during the simulation, and all survivors would die at the end of the last cycle.…”

Economic evaluation of stent retrievers in basilar artery occlusion: An analysis from Chinese healthcare system perspective

“…The expenses within the decision tree and Markov model were combined to compute the overall cost, while the total effectiveness was determined using an analogous approach. The conversion of all costs to USD was based on the exchange rate of 6.4515 Chinese Yuan (CNY) to 1 USD [19]. Following the principles set forth by the China Guidelines for Pharmacoeconomic Evaluations, expenses occurring prior to 2021 and future costs were discounted at a rate of 0.05, with a variation between 0 and 0.08 [20].…”