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Cost-effectiveness analysis of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation: a systematic review

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Abstract

To assess the cost-effectiveness of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation and heart failure, a systematic literature search was conducted in various electronic databases to January 3, 2020. Eligibility criteria are the population (patients with mitral regurgitation (MR)), intervention (transcatheter mitral valve repair using the MitraClip), comparator (conventional medical treatment), outcomes, and designs (Model-based or trial-based full economic evaluations).The quality of included studies was assessed using the CHEERS checklist. Mortality and survival rate, quality-adjusted life year (QALY), life years gained (LYG), total cost, and the incremental cost-effectiveness ratio (ICER) regarding the use of MitraClip System were considered as the key outcomes. Eight articles were eligible for full-text assessment. Ultimately, a total of seven studies were considered in the current systematic review. Results demonstrated that MitraClip reduces mortality rate and increases survival rate. The mortality rate at 1 year and 10 years was 16.7% versus 29.77% and 70.9% versus 98.8%, respectively. Total cost data based on 2019 USD show that the MitraClip has the highest cost in the USA ($121,390) and the lowest cost in Italy ($33,062). The results showed that in all selected countries, willingness-to-pay (WTP) thresholds are upper than the cost per QALY; also, the highest ICER for the MitraClip is in the USA ($55,600/QALY) and the lowest in Italy ($10,616/QALY). To conclude, evidence from this systematic review suggests that MitraClip Delivery System improved both life expectancy and QALY compared with medical treatment in patients at high surgical risk and it was also a cost-effective treatment option for patients with mitral regurgitation.

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Acknowledgments

We would like to thank all who helped us through writing the article.

Funding

This study is an extract from the research project with the Code of Ethics IR.IUMS.REC.1398.1075 from Iran University of Medical Sciences, which has been conducted and supported at the Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

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Authors and Affiliations

  1. Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

    Aziz Rezapour, Samad Azari, Jalal Arabloo & Vahid Alipour

  2. Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran

    Samad Azari & Hamid Pourasghari

  3. Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran

    Masoud Behzadifar

  4. Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

    Negar Omidi

  5. Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

    Saeed Sadeghian & Hassan Aghajani

  6. Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Canada

    Nicola Luigi Bragazzi

Authors
  1. Aziz Rezapour
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  2. Samad Azari
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  3. Jalal Arabloo
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  4. Hamid Pourasghari
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  5. Masoud Behzadifar
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  6. Vahid Alipour
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  7. Negar Omidi
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  8. Saeed Sadeghian
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  9. Hassan Aghajani
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  10. Nicola Luigi Bragazzi
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Contributions

Conceptualization: SA, NO, AR. Leading the overall coordination: SA, AZ. Data compilation and analysis: SA, JA. Writing the first draft: SA, MB, NO. Data interpretation: SA, AR. Data provision: AZ, VA, JA. Critical revision of the manuscript: NO, NLB. Reading and approval of the final manuscript: all authors.

Corresponding author

Correspondence to Samad Azari.

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The authors declare that they have no conflict of interest.

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Rezapour, A., Azari, S., Arabloo, J. et al. Cost-effectiveness analysis of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation: a systematic review. Heart Fail Rev 26, 587–601 (2021). https://doi.org/10.1007/s10741-020-10055-9

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  • DOI: https://doi.org/10.1007/s10741-020-10055-9

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