Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings

Borisenko, O.; Haude, Michael; Hoppe, Uta C.; Siminiak, Tomasz; Lipiecki, Janusz; Goldberg, Steve; Mehta, N.; Bouknight, Omari V; Bjessmo, Staffan; Reuter, David G.

doi:10.1186/s12872-015-0039-8

Cited by 13 publications

(7 citation statements)

References 42 publications

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“…Utility values for each health state were derived on the basis of values from other health economic evaluations of HF interventions. NYHA classes are commonly used to categorize patients with HF based on severity of symptoms, and studies have estimated utility values for each class [ 60 , 62 , 68 , 69 ]. All utilities and the sources of the values are presented in Table 2 .…”

Section: Methodsmentioning

confidence: 99%

Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis

et al. 2020

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Background Heart failure (HF) is a major public health issue in Canada that is associated with high prevalence, morbidity, and mortality rates and high financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory patients with HF that has been found to improve patient outcomes. However, the cost-effectiveness of the Medly program is yet to be determined. Objective This study aims to conduct a cost-utility analysis of the Medly program compared with the standard of care for HF in Ontario, Canada, from the perspective of the public health care payer. Methods Using a microsimulation model, individual patient data were simulated over a 25-year time horizon to compare the costs and quality-adjusted life years (QALYs) between the Medly program and standard care for patients with HF treated in the ambulatory care setting. Data were sourced from a Medly Program Evaluation study and literature to inform model parameters, such as Medly’s effectiveness in reducing mortality and hospitalizations, health care and intervention costs, and model transition probabilities. Scenario analyses were conducted in relation to HF severity and TM deployment models. One-way deterministic effectiveness analysis and probabilistic sensitivity analysis were performed to explore the impact on the results of uncertainty in model parameters. Results The Medly program was associated with an average total cost of Can $102,508 (US $77,626) per patient and total QALYs of 5.51 per patient compared with the average cost of Can $97,497 (US $73,831) and QALYs of 4.95 per patient in the Standard Care Group. This led to an incremental cost of Can $5011 (US $3794) and incremental QALY of 0.566, resulting in an incremental cost-effectiveness ratio of Can $8850 (US $6701)/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models in which patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness greater than 85% at a willingness-to-pay threshold of Can $50,000 (US $37,718). Although the results showed some sensitivity to assumptions about effectiveness parameters, the intervention was found to remain cost-effective. Conclusions The Medly program for patients with HF is cost-effective compared with standard care using commonly reported willingness-to-pay thresholds. This study provides evidence for decision makers on the use of TM for HF, supports the use of a nurse-led model of TM that embeds clinically validated algorithms, and informs the use of economic modeling for future evaluations of early-stage health informatics technology.

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Section: Methodsmentioning

confidence: 99%

Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis

et al. 2020

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“…However, there was a paucity of data reporting on health-related quality of life and resource use by MR severity. Additionally, A c c e p t e d M a n u s c r i p t previously published models in this disease area are based primarily around NYHA class [34,35,36].…”

Section: Model Structurementioning

confidence: 99%

An analysis of the cost-effectiveness of transcatheter mitral valve repair for people with secondary mitral valve regurgitation in the UK

Shore

Russell

Frankenstein

et al. 2020

Journal of Medical Economics

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Introduction and aims A proportion of chronic heart failure (CHF) patients will experience regurgitation secondary to ventricular remodelling in CHF, known as functional mitral (MR) or tricuspid (TR) regurgitation. Its presence adversely impacts prognosis and healthcare utilisation in CHF patients. The advent of interventional devices for both atrioventricular valves modifies both aspects. We present an economic model structure suitable for comparing interventions used in MR and TR, and assess the cost-effectiveness of transcatheter mitral valve repair (TMVr) plus guideline directed medical therapy (GDMT) compared with GDMT alone in people with MR. Methods An economic model with a lifetime time horizon was developed based on extrapolated survival data and using New York Heart Association classifications to describe disease severity in people with functional MR at high risk of surgical mortality or deemed inoperable. Cost and utility values (describing health related quality of life) were assigned to patients dependent on their disease severity. The analysis was conducted from a UK National Health Service perspective. An incremental cost per additional quality-adjusted life year (QALY) was estimated, and sensitivity (one-way and probabilistic) and scenario analyses conducted. Results and conclusions Compared with GDMT, the use of TMVr results in an additional 1.07 QALYs and an increase in costs of £32,267 per patient over a lifetime time horizon. The estimated incremental cost A c c e p t e d M a n u s c r i p t per QALY gained is £30,057 and would therefore be on the threshold of cost-effectiveness at £30,000 per quality adjusted life year. Thus, from a UK reimbursement perspective, in patients with severe functional MR who are at high risk of surgical mortality or deemed inoperable with conventional surgery, TMVr plus medical therapy is likely to represent a cost-effective treatment option compared with GDMT alone. The choice of device (MitraClip or PASCAL) will need to be confirmed once further clinical data are reported.

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“…Utility values for each health state were derived on the basis of values from other health economic evaluations of HF interventions. NYHA classes are commonly used to categorize patients with HF based on severity of symptoms, and studies have estimated utility values for each class [60,62,68,69]. All utilities and the sources of the values are presented in Table 2.…”

Section: Measurement and Evaluation Of Healthmentioning

confidence: 99%

Evaluation of a Heart Failure Telemonitoring Program Through a Microsimnulation Model: Cost-Utility Analysis (Preprint)

Boodoo¹,

Zhang²,

Ross³

et al. 2020

Preprint

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BACKGROUND Heart failure (HF) is a major public health issue in Canada associated with a high prevalence, morbidity, mortality, as well as financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory HF patients that has been found to improve patient outcomes. However, the cost-effectivness of the Medly program has yet to be determined. OBJECTIVE To conduct a cost-utility analysis of the Medly program compared to the standard of care for HF from a public payer perspective. METHODS Using a microsimulation model, individual patient datawere simulated over a 25-year time horizon to compare the costs and QALYs between the Medly program and standard care for patients with HF treated in the ambulatory care setting. Data were sourced from a Medly program evaluation study and literature to inform model parameters, such as Medly’s effectiveness in reducing mortality and hospitalizations, health care and intervention costs, and model transition probabilities. Scenario analyses were conducted in relation to HF severity and TM deployment models. One-way deterministic effectiveness analysis as well as probalistic sensitivity analysis were performed to explore the impact on the results of uncertainty in model parameters. RESULTS The Medly program was associated with an average total cost of $102,508 per patient and total QALYs of 5.51 per patient compared to $97,497 and 4.95 QALYs in the standard care group. This led to an incremental cost of $5,011 and incremental QALY of 0.566 resulting in an ICER of $8,850/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models where patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness >85% at a willingness-to-pay threshold of $50,000. While the results showed some sensitivity to assumptions about effectiveness parameters, the intervention was found to remain cost-effective. CONCLUSIONS The Medly program for patients with HF is cost-effective compared to standard care. This study provides evidence for decision makers on the use of TM for HF, supports the use of a nurse-led model of TM that embeds clinically validated algorithms, and informs the use of economic modeling for future evaluations of early-stage health informatics technology.

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Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings

Cited by 13 publications

References 42 publications

Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis

Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis

An analysis of the cost-effectiveness of transcatheter mitral valve repair for people with secondary mitral valve regurgitation in the UK

Evaluation of a Heart Failure Telemonitoring Program Through a Microsimnulation Model: Cost-Utility Analysis (Preprint)

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