title: Real-world cost effectiveness of MitraClip combined with Medical Therapy Versus Medical therapy alone in patients with moderate or severe mitral regurgitation.
abstract: BACKGROUND
  We evaluated the real-world cost-effectiveness of the MitraClip system (Abbott Vascular Inc., Menlo Park, CA) plus medical therapy for patients with moderate/severe mitral regurgitation, as compared with medical therapy (MT) alone.
  
  
  METHODS
  Clinical records of patients with moderate to severe functional mitral regurgitation treated with MitraClip (N=232) or with MT (N=151) were collected and outcome analyzed with propensity score adjustment to reduce selection bias. Twelve-month outcomes were modeled over a lifetime horizon to conduct a cost-effectiveness analysis, in the payer's perspective. Costs and benefits were discounted at an annual rate of 3.5%.
  
  
  RESULTS
  After propensity score adjustment, the average treatment effect was -9.5% probability of dying at 12months and, following lifetime modeling, 3.35±0.75 incremental life years and 3.01±0.57 incremental quality-adjusted life years. MitraClip contributed to a higher decrease in re-hospitalizations at 12months (difference=-0.54±0.08) and generated a more likely improvement in the New York Heart Association (NYHA) class at 12months versus NYHA at enrollment. Incremental costs, adapted to five possible scenarios, ranged from 14,493 to 29,795 € contributing to an incremental cost-effectiveness ratio ranging from 4796 to 7908 €.
  
  
  CONCLUSIONS
  Compared to MT alone and given conventional threshold values, MitraClip can be considered a cost-effective procedure. The cost-effectiveness of MitraClip is in line or superior to the one of other non-pharmaceutical strategies for heart failure.
authors.affiliation: CERGAS (Centre for Research on Social and Healthcare Management) Bocconi University, Milan, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Armeni
authors.affiliation: CERGAS (Centre for Research on Social and Healthcare Management) Bocconi University, Milan, Italy.
authors.forename: Paola R
authors.initials: PR
authors.lastname: Boscolo
authors.affiliation: CERGAS (Centre for Research on Social and Healthcare Management) Bocconi University, Milan, Italy; Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Tarricone
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy. Electronic address: dcapodanno@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: ANMCO Research Centre, Firenze, Italy.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Grasso
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Cardiovascular Surgery Department, University Hospital of Zurich, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000401:mortality / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation / Q000191:economics* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends
chemical_list: D002316:Cardiotonic Agents