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Conflicting findings between the Mitra-Fr and the Coapt trials: Implications regarding the cost-effectiveness of percutaneous repair for heart failure patients with severe secondary mitral regurgitation
- Source :
- PLoS ONE, Vol 15, Iss 11, p e0241361 (2020), PLoS ONE, PLoS ONE, 2020, 15, ⟨10.1371/journal.pone.0241361⟩
- Publication Year :
- 2020
- Publisher :
- Public Library of Science (PLoS), 2020.
-
Abstract
- Purpose Two randomized controlled trials (RCTs), Mitra-Fr and Coapt, evaluating the benefit of percutaneous repair (PR) for heart failure (HF) patients with severe mitral regurgitation, have led to conflicting results. We aimed to evaluate the impact of these trial results on the cost-effectiveness of PR using effectiveness inputs from the two RCTs. Methods We developed a time varying Markov type model with three mutually exclusive health states: alive without HF hospitalisation, alive with HF hospitalisation, and dead. Clinically plausible extrapolations beyond observed data were obtained by developing parametric modelling for overall survival and HF hospitalisations using published data from each trial. We adopted the perspective of the French Health System and used a 30-year time horizon. Results were expressed as € / quality-adjusted life year (QALY) gained using utility inputs from literature. Findings Results are presented using treatment efficacy measures from Mitra-F and Coapt trials respectively. With the Mitra-Fr data, after annual discounting, the base case model generated an incremental 0.00387 QALY at a cost of €25,010, yielding an incremental cost effectiveness ratio (ICER) of €6,467,032 / QALY. The model was sensitive to changes made to model inputs. There was no potential of PR being cost-effective. With the Coapt data, the model generated 1.19 QALY gain at a cost of €26,130 yielding an ICER of €21,918 / QALY and at a threshold of >€50,000/QALY PR had a probability of 1 of being cost-effective. Implications Cost effectiveness results were conflicting; reconciling differences between trials is a priority and could promote optimal cost effectiveness analyses and resource allocation.
- Subjects :
- Economics
Cost effectiveness
Cost-Benefit Analysis
Extrapolation
Social Sciences
030204 cardiovascular system & hematology
law.invention
0302 clinical medicine
Randomized controlled trial
law
Medicine and Health Sciences
030212 general & internal medicine
Randomized Controlled Trials as Topic
[PHYS]Physics [physics]
Numerical Analysis
Percutaneous repair
Multidisciplinary
Mitral Valve Insufficiency
3. Good health
Case model
Physical Sciences
Engineering and Technology
Medicine
Incremental cost-effectiveness ratio
Research Article
Biotechnology
medicine.medical_specialty
Drug Research and Development
Death Rates
Science
Cost-Effectiveness Analysis
Cardiology
Bioengineering
Research and Analysis Methods
03 medical and health sciences
Percutaneous Coronary Intervention
Health Economics
Population Metrics
medicine
Humans
Clinical Trials
Intensive care medicine
Heart Failure
Pharmacology
Mitral regurgitation
Discounting
Population Biology
business.industry
Biology and Life Sciences
medicine.disease
Economic Analysis
Randomized Controlled Trials
Health Care
Heart failure
Medical Devices and Equipment
Clinical Medicine
business
Mathematics
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 15
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....335916aa753e0f8fc6eb409869c72e44