Transcatheter mitral valve repair (TMVr) is a reasonable treatment strategy for symptomatic heart failure patients with 3-4+ secondary mitral regurgitation (SMR) based on both clinical and economic considerations, said researchers presenting an analysis of COAPT trial data at TCT 2019. The findings were also published Sept. 29 in Circulation.

Suzanne J. Baron, MD, MSc, and colleagues used data from the COAPT trial to perform a formal, patient-level economic analysis of TMVr with guideline-directed medical therapy (GDMT) vs. GDMT alone for patients with heart failure and 3-4+ SMR. Baron, et al., assessed costs for the index TMVr hospitalization using a combination of resource-based accounting and hospital billing data when available, while follow-up medical care costs were estimated based on data collected during the COAPT trial. Health utilities were estimated for all patients at baseline, one month, six months, 12 months and 24 months.

Results found initial costs for the TMVr procedure and index hospitalization were $35,755 and $48,198, respectively. While researchers noted follow-up costs were significantly lower with TMVr compared with GDMT ($26,654 vs. $38,345), the cumulative two-year costs remained higher with TMVr because of up-front costs associated with the index hospitalization ($73,416 vs. $38,345). Modeled over a lifetime horizon, TMVr was projected to increase life-expectancy by 1.13 years and quality-adjusted life-years (QALYs) by 0.82 years at a cost of $45,648, researchers said. This would yield a lifetime incremental cost-effectiveness ratio of $40,361/life-year gained and $55,600/QALY gained based on current U.S. thresholds.

"This is the first study to evaluate the cost-effectiveness of TMVr vs. GDMT in patients with 3-4+ SMR and heart failure from the perspective of the U.S. health care system," according to Baron and colleagues. They suggest future studies are needed "to examine the durability of TMVr benefit in this population and to evaluate the cost-effectiveness of TMVr compared with other available and emerging mitral valve therapies."

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging, Mitral Regurgitation

Keywords: TCT19, Transcatheter Cardiovascular Therapeutics, Angiography, Mitral Valve Insufficiency, Cost-Benefit Analysis, Heart Failure, Heart Valve Prosthesis Implantation, Percutaneous Coronary Intervention

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