Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation

Bart S. Ferket; Vinod H. Thourani; Pierre Voisine; Samuel F. Hohmann; Helena L. Chang; Peter K. Smith; Robert E. Michler; Gorav Ailawadi; Louis P. Perrault; Marissa A. Miller; Karen O'Sullivan; Stephanie L. Mick; Emilia Bagiella; Michael A. Acker; Ellen Moquete; Judy W. Hung; Jessica R. Overbey; Anuradha Lala; Margaret Iraola; James S. Gammie; Annetine C. Gelijns; Patrick T. O'Gara; Alan J. Moskowitz; Wendy C. Taddei-Peters; Dennis Buxton; Ron Caulder; Nancy L. Geller; David Gordon; Neal O. Jeffries; Albert Lee; Claudia S. Moy; Ilana Kogan Gombos; Jennifer Ralph; Richard Weisel; Timothy J. Gardner; Eric A. Rose; Michael K. Parides; Deborah D. Ascheim; Helena Chang; Melissa Chase; Yingchun Chen; Seth Goldfarb; Lopa Gupta; Katherine Kirkwood; Edlira Dobrev; Ron Levitan; Jessica Overbey; Milerva Santos; Michael Weglinski; Paula Williams; Carrie Wood; Xia Ye; Sten Lyager Nielsen; Henrik Wiggers; Henning Malgaard; Michael Mack; Tracine Adame; Natalie Settele; Jenny Adams; William Ryan; Robert L. Smith; Paul Grayburn; Frederick Y. Chen; Anju Nohria; Lawrence Cohn; Prem Shekar; Sary Aranki; Gregory Couper; Michael Davidson; R. Morton Bolman; Anne Burgess; Debra Conboy; Nicolas Noiseux; Louis Mathieu Stevens; Ignacio Prieto; Fadi Basile; Joannie Dionne; Julie Fecteau; Eugene H. Blackstone; A. Marc Gillinov; Pamela Lackner; Leoma Berroteran; Diana Dolney; Suzanne Fleming; Roberta Palumbo; Christine Whitman; Kathy Sankovic; Denise Kosty Sweeney; Gregory Pattakos; Pamela A. Clarke; Michael Argenziano; Mathew Williams; Lyn Goldsmith; Craig R. Smith; Yoshifumi Naka; Allan Stewart; Allan Schwartz; Daniel Bell; Danielle Van Patten; Sowmya Sreekanth; John H. Alexander; Carmelo A. Milano; Donald D. Glower; Joseph P. Mathew; J. Kevin Harrison; Stacey Welsh; Mark F. Berry; Cyrus J. Parsa; Betty C. Tong; Judson B. Williams; T. Bruce Ferguson; Alan P. Kypson; Evelio Rodriguez; Malissa Harris; Brenda Akers; Allison O'Neal; John D. Puskas; Robert Guyton; Jefferson Baer; Kim Baio; Alexis A. Neill; Mario Senechal; François Dagenais; Kim O'Connor; Gladys Dussault; Tatiana Ballivian; Suzanne Keilani; Alan M. Speir; Patrick Magee; Niv Ad; Sally Keyte; Minh Dang; Mark Slaughter; Marsha Headlee; Heather Moody; Naresh Solankhi; Emma Birks; Mark A. Groh; Leslie E. Shell; Stephanie A. Shepard; Benjamin H. Trichon; Tracy Nanney; Lynne C. Hampton; David A. D'Alessandro; Joseph J. DeRose; Daniel J. Goldstein; Ricardo Bello; William Jakobleff; Mario Garcia; Cynthia Taub; Daniel Spevak; Roger Swayze; Arsène Joseph Basmadjian; Denis Bouchard; Michel Carrier; Raymond Cartier; Michel Pellerin; Jean François Tanguay; Ismail El-Hamamsy; André Denault; Philippe Demers; Sophie Robichaud; Keith A. Horvath; Philip C. Corcoran; Michael P. Siegenthaler; Mandy Murphy; Ann Greenberg; Chittoor Sai-Sudhakar; Ayseha Hasan; Asia McDavid; Bradley Kinn; Pierre Pagé; Carole Sirois; David Latter; Howard Leong-Poi; Daniel Bonneau; Lee Errett; Mark D. Peterson; Subodh Verma; Randi Feder-Elituv; Gideon Cohen; Campbell Joyner; Stephen E. Fremes; Fuad Moussa; George Christakis; Reena Karkhanis; Terry Yau; Michael Farkouh; Anna Woo; Robert James Cusimano; Tirone David; Christopher Feindel; Lisa Garrard; Suzanne Fredericks; Amelia Mociornita; John C. Mullen; Jonathan Choy; Steven Meyer; Emily Kuurstra; Cindi A. Young; Dana Beach; Pavan Atluri; Y. Joseph Woo; Mary Lou Mayer; Michael Bowdish; Vaughn A. Starnes; David Shavalle; Ray Matthews; Shadi Javadifar; Linda Romar; Irving L. Kron; Karen Johnston; John M. Dent; John Kern; Jessica Keim; Sandra Burks; Kim Gahring; David A. Bull; Patrice Desvigne-Nickens; Dennis O. Dixon; Mark Haigney; Richard Holubkov; Alice Jacobs; Frank Miller; John M. Murkin; John Spertus; Andrew S. Wechsler; Frank Sellke; Cheryl L. McDonald; Robert Byington; Neal Dickert; John S. Ikonomidis; David O. Williams; Clyde W. Yancy; James C. Fang; Nadia Giannetti; Wayne Richenbacher; Vivek Rao; Karen L. Furie; Rachel Miller; Sean Pinney; William C. Roberts; Mary N. Walsh; Stephen J. Keteyian; Clinton A. Brawner; Heather Aldred; Judy Hung; Xin Zeng; Jeffrey Browndyke; Yanne Toulgoat-Dubois

doi:10.1016/j.jtcvs.2019.06.040

Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation

Bart S. Ferket, Vinod H. Thourani, Pierre Voisine, Samuel F. Hohmann, Helena L. Chang, Peter K. Smith, Robert E. Michler, Gorav Ailawadi, Louis P. Perrault, Marissa A. Miller, Karen O'Sullivan, Stephanie L. Mick, Emilia Bagiella, Michael A. Acker, Ellen Moquete, Judy W. Hung, Jessica R. Overbey, Anuradha Lala, Margaret Iraola, James S. GammieAnnetine C. Gelijns, Patrick T. O'Gara, Alan J. Moskowitz, Wendy C. Taddei-Peters, Dennis Buxton, Ron Caulder, Nancy L. Geller, David Gordon, Neal O. Jeffries, Albert Lee, Claudia S. Moy, Ilana Kogan Gombos, Jennifer Ralph, Richard Weisel, Timothy J. Gardner, Eric A. Rose, Michael K. Parides, Deborah D. Ascheim, Helena Chang, Melissa Chase, Yingchun Chen, Seth Goldfarb, Lopa Gupta, Katherine Kirkwood, Edlira Dobrev, Ron Levitan, Jessica Overbey, Milerva Santos, Michael Weglinski, Paula Williams, Carrie Wood, Xia Ye, Sten Lyager Nielsen, Henrik Wiggers, Henning Malgaard, Michael Mack, Tracine Adame, Natalie Settele, Jenny Adams, William Ryan, Robert L. Smith, Paul Grayburn, Frederick Y. Chen, Anju Nohria, Lawrence Cohn, Prem Shekar, Sary Aranki, Gregory Couper, Michael Davidson, R. Morton Bolman, Anne Burgess, Debra Conboy, Nicolas Noiseux, Louis Mathieu Stevens, Ignacio Prieto, Fadi Basile, Joannie Dionne, Julie Fecteau, Eugene H. Blackstone, A. Marc Gillinov, Pamela Lackner, Leoma Berroteran, Diana Dolney, Suzanne Fleming, Roberta Palumbo, Christine Whitman, Kathy Sankovic, Denise Kosty Sweeney, Gregory Pattakos, Pamela A. Clarke, Michael Argenziano, Mathew Williams, Lyn Goldsmith, Craig R. Smith, Yoshifumi Naka, Allan Stewart, Allan Schwartz, Daniel Bell, Danielle Van Patten, Sowmya Sreekanth, John H. Alexander, Carmelo A. Milano, Donald D. Glower, Joseph P. Mathew, J. Kevin Harrison, Stacey Welsh, Mark F. Berry, Cyrus J. Parsa, Betty C. Tong, Judson B. Williams, T. Bruce Ferguson, Alan P. Kypson, Evelio Rodriguez, Malissa Harris, Brenda Akers, Allison O'Neal, John D. Puskas, Robert Guyton, Jefferson Baer, Kim Baio, Alexis A. Neill, Mario Senechal, François Dagenais, Kim O'Connor, Gladys Dussault, Tatiana Ballivian, Suzanne Keilani, Alan M. Speir, Patrick Magee, Niv Ad, Sally Keyte, Minh Dang, Mark Slaughter, Marsha Headlee, Heather Moody, Naresh Solankhi, Emma Birks, Mark A. Groh, Leslie E. Shell, Stephanie A. Shepard, Benjamin H. Trichon, Tracy Nanney, Lynne C. Hampton, David A. D'Alessandro, Joseph J. DeRose, Daniel J. Goldstein, Ricardo Bello, William Jakobleff, Mario Garcia, Cynthia Taub, Daniel Spevak, Roger Swayze, Arsène Joseph Basmadjian, Denis Bouchard, Michel Carrier, Raymond Cartier, Michel Pellerin, Jean François Tanguay, Ismail El-Hamamsy, André Denault, Philippe Demers, Sophie Robichaud, Keith A. Horvath, Philip C. Corcoran, Michael P. Siegenthaler, Mandy Murphy, Ann Greenberg, Chittoor Sai-Sudhakar, Ayseha Hasan, Asia McDavid, Bradley Kinn, Pierre Pagé, Carole Sirois, David Latter, Howard Leong-Poi, Daniel Bonneau, Lee Errett, Mark D. Peterson, Subodh Verma, Randi Feder-Elituv, Gideon Cohen, Campbell Joyner, Stephen E. Fremes, Fuad Moussa, George Christakis, Reena Karkhanis, Terry Yau, Michael Farkouh, Anna Woo, Robert James Cusimano, Tirone David, Christopher Feindel, Lisa Garrard, Suzanne Fredericks, Amelia Mociornita, John C. Mullen, Jonathan Choy, Steven Meyer, Emily Kuurstra, Cindi A. Young, Dana Beach, Pavan Atluri, Y. Joseph Woo, Mary Lou Mayer, Michael Bowdish, Vaughn A. Starnes, David Shavalle, Ray Matthews, Shadi Javadifar, Linda Romar, Irving L. Kron, Karen Johnston, John M. Dent, John Kern, Jessica Keim, Sandra Burks, Kim Gahring, David A. Bull, Patrice Desvigne-Nickens, Dennis O. Dixon, Mark Haigney, Richard Holubkov, Alice Jacobs, Frank Miller, John M. Murkin, John Spertus, Andrew S. Wechsler, Frank Sellke, Cheryl L. McDonald, Robert Byington, Neal Dickert, John S. Ikonomidis, David O. Williams, Clyde W. Yancy, James C. Fang, Nadia Giannetti, Wayne Richenbacher, Vivek Rao, Karen L. Furie, Rachel Miller, Sean Pinney, William C. Roberts, Mary N. Walsh, Stephen J. Keteyian, Clinton A. Brawner, Heather Aldred, Judy Hung, Xin Zeng, Jeffrey Browndyke, Yanne Toulgoat-Dubois

Internal Medicine

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Objective: The Cardiothoracic Surgical Trials Network reported that left ventricular reverse remodeling at 2 years did not differ between patients with moderate ischemic mitral regurgitation randomized to coronary artery bypass grafting plus mitral valve repair (n = 150) or coronary artery bypass grafting alone (n = 151). To address health resource use implications, we compared costs and quality-adjusted survival. Methods: We used individual patient data from the Cardiothoracic Surgical Trials Network trial on survival, hospitalizations, quality of life, and US hospitalization costs to estimate cumulative costs and quality-adjusted life years. A microsimulation model was developed to extrapolate to 10 years. Bootstrap and deterministic sensitivity analyses were performed to address uncertainty. Results: In-hospital costs were $59,745 for coronary artery bypass grafting plus mitral valve repair versus $51,326 for coronary artery bypass grafting alone (difference $8419; 95% uncertainty interval, 2259-18,757). Two-year costs were $81,263 versus $67,341 (difference 13,922 [2370 to 28,888]), and quality-adjusted life years were 1.35 versus 1.30 (difference 0.05; −0.04 to 0.14), resulting in an incremental cost-effectiveness ratio of $308,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ($107,733 vs $88,583, difference 19,150 [−3866 to 56,826]) and quality-adjusted life years showed no difference (−0.92 to 0.87), with 5.08 versus 5.08. The likelihood that coronary artery bypass grafting plus mitral valve repair would be considered cost-effective at 10 years based on a cost-effectiveness threshold of $100K/quality-adjusted life year did not exceed 37%. Only when this procedure reduces the death rate by a relative 5% will the incremental cost-effectiveness ratio fall below $100K/quality-adjusted life year. Conclusions: The addition of mitral valve repair to coronary artery bypass grafting for patients with moderate ischemic mitral regurgitation is unlikely to be cost-effective. Only if late mortality benefits can be demonstrated will it meet commonly used cost-effectiveness criteria.

Original language	English
Pages (from-to)	2230-2240.e15
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	159
Issue number	6
DOIs	https://doi.org/10.1016/j.jtcvs.2019.06.040
State	Published - Jun 2020

Bibliographical note

Publisher Copyright:
© 2019 The American Association for Thoracic Surgery

Keywords

CABG
Cardiothoracic Surgical Trials Network
cost-effectiveness analysis
health care costs
ischemic mitral regurgitation
mitral valve
mitral valve repair
quality-adjusted life years

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jtcvs.2019.06.040

Cite this

Ferket, B. S., Thourani, V. H., Voisine, P., Hohmann, S. F., Chang, H. L., Smith, P. K., Michler, R. E., Ailawadi, G., Perrault, L. P., Miller, M. A., O'Sullivan, K., Mick, S. L., Bagiella, E., Acker, M. A., Moquete, E., Hung, J. W., Overbey, J. R., Lala, A., Iraola, M., ... Toulgoat-Dubois, Y. (2020). Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation. Journal of Thoracic and Cardiovascular Surgery, 159(6), 2230-2240.e15. https://doi.org/10.1016/j.jtcvs.2019.06.040

@article{fe1282c015594f9b9ea3dcb1b5dfd7b1,

title = "Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation",

abstract = "Objective: The Cardiothoracic Surgical Trials Network reported that left ventricular reverse remodeling at 2 years did not differ between patients with moderate ischemic mitral regurgitation randomized to coronary artery bypass grafting plus mitral valve repair (n = 150) or coronary artery bypass grafting alone (n = 151). To address health resource use implications, we compared costs and quality-adjusted survival. Methods: We used individual patient data from the Cardiothoracic Surgical Trials Network trial on survival, hospitalizations, quality of life, and US hospitalization costs to estimate cumulative costs and quality-adjusted life years. A microsimulation model was developed to extrapolate to 10 years. Bootstrap and deterministic sensitivity analyses were performed to address uncertainty. Results: In-hospital costs were $59,745 for coronary artery bypass grafting plus mitral valve repair versus $51,326 for coronary artery bypass grafting alone (difference $8419; 95% uncertainty interval, 2259-18,757). Two-year costs were $81,263 versus $67,341 (difference 13,922 [2370 to 28,888]), and quality-adjusted life years were 1.35 versus 1.30 (difference 0.05; −0.04 to 0.14), resulting in an incremental cost-effectiveness ratio of $308,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ($107,733 vs $88,583, difference 19,150 [−3866 to 56,826]) and quality-adjusted life years showed no difference (−0.92 to 0.87), with 5.08 versus 5.08. The likelihood that coronary artery bypass grafting plus mitral valve repair would be considered cost-effective at 10 years based on a cost-effectiveness threshold of $100K/quality-adjusted life year did not exceed 37%. Only when this procedure reduces the death rate by a relative 5% will the incremental cost-effectiveness ratio fall below $100K/quality-adjusted life year. Conclusions: The addition of mitral valve repair to coronary artery bypass grafting for patients with moderate ischemic mitral regurgitation is unlikely to be cost-effective. Only if late mortality benefits can be demonstrated will it meet commonly used cost-effectiveness criteria.",

keywords = "CABG, Cardiothoracic Surgical Trials Network, cost-effectiveness analysis, health care costs, ischemic mitral regurgitation, mitral valve, mitral valve repair, quality-adjusted life years",

author = "Ferket, {Bart S.} and Thourani, {Vinod H.} and Pierre Voisine and Hohmann, {Samuel F.} and Chang, {Helena L.} and Smith, {Peter K.} and Michler, {Robert E.} and Gorav Ailawadi and Perrault, {Louis P.} and Miller, {Marissa A.} and Karen O'Sullivan and Mick, {Stephanie L.} and Emilia Bagiella and Acker, {Michael A.} and Ellen Moquete and Hung, {Judy W.} and Overbey, {Jessica R.} and Anuradha Lala and Margaret Iraola and Gammie, {James S.} and Gelijns, {Annetine C.} and O'Gara, {Patrick T.} and Moskowitz, {Alan J.} and Taddei-Peters, {Wendy C.} and Dennis Buxton and Ron Caulder and Geller, {Nancy L.} and David Gordon and Jeffries, {Neal O.} and Albert Lee and Moy, {Claudia S.} and Gombos, {Ilana Kogan} and Jennifer Ralph and Richard Weisel and Gardner, {Timothy J.} and Rose, {Eric A.} and Parides, {Michael K.} and Ascheim, {Deborah D.} and Helena Chang and Melissa Chase and Yingchun Chen and Seth Goldfarb and Lopa Gupta and Katherine Kirkwood and Edlira Dobrev and Ron Levitan and Jessica Overbey and Milerva Santos and Michael Weglinski and Paula Williams and Carrie Wood and Xia Ye and Nielsen, {Sten Lyager} and Henrik Wiggers and Henning Malgaard and Michael Mack and Tracine Adame and Natalie Settele and Jenny Adams and William Ryan and Smith, {Robert L.} and Paul Grayburn and Chen, {Frederick Y.} and Anju Nohria and Lawrence Cohn and Prem Shekar and Sary Aranki and Gregory Couper and Michael Davidson and Bolman, {R. Morton} and Anne Burgess and Debra Conboy and Nicolas Noiseux and Stevens, {Louis Mathieu} and Ignacio Prieto and Fadi Basile and Joannie Dionne and Julie Fecteau and Blackstone, {Eugene H.} and Gillinov, {A. Marc} and Pamela Lackner and Leoma Berroteran and Diana Dolney and Suzanne Fleming and Roberta Palumbo and Christine Whitman and Kathy Sankovic and Sweeney, {Denise Kosty} and Gregory Pattakos and Clarke, {Pamela A.} and Michael Argenziano and Mathew Williams and Lyn Goldsmith and Smith, {Craig R.} and Yoshifumi Naka and Allan Stewart and Allan Schwartz and Daniel Bell and {Van Patten}, Danielle and Sowmya Sreekanth and Alexander, {John H.} and Milano, {Carmelo A.} and Glower, {Donald D.} and Mathew, {Joseph P.} and Harrison, {J. Kevin} and Stacey Welsh and Berry, {Mark F.} and Parsa, {Cyrus J.} and Tong, {Betty C.} and Williams, {Judson B.} and Ferguson, {T. Bruce} and Kypson, {Alan P.} and Evelio Rodriguez and Malissa Harris and Brenda Akers and Allison O'Neal and Puskas, {John D.} and Robert Guyton and Jefferson Baer and Kim Baio and Neill, {Alexis A.} and Mario Senechal and Fran{\c c}ois Dagenais and Kim O'Connor and Gladys Dussault and Tatiana Ballivian and Suzanne Keilani and Speir, {Alan M.} and Patrick Magee and Niv Ad and Sally Keyte and Minh Dang and Mark Slaughter and Marsha Headlee and Heather Moody and Naresh Solankhi and Emma Birks and Groh, {Mark A.} and Shell, {Leslie E.} and Shepard, {Stephanie A.} and Trichon, {Benjamin H.} and Tracy Nanney and Hampton, {Lynne C.} and D'Alessandro, {David A.} and DeRose, {Joseph J.} and Goldstein, {Daniel J.} and Ricardo Bello and William Jakobleff and Mario Garcia and Cynthia Taub and Daniel Spevak and Roger Swayze and Basmadjian, {Ars{\`e}ne Joseph} and Denis Bouchard and Michel Carrier and Raymond Cartier and Michel Pellerin and Tanguay, {Jean Fran{\c c}ois} and Ismail El-Hamamsy and Andr{\'e} Denault and Philippe Demers and Sophie Robichaud and Horvath, {Keith A.} and Corcoran, {Philip C.} and Siegenthaler, {Michael P.} and Mandy Murphy and Ann Greenberg and Chittoor Sai-Sudhakar and Ayseha Hasan and Asia McDavid and Bradley Kinn and Pierre Pag{\'e} and Carole Sirois and David Latter and Howard Leong-Poi and Daniel Bonneau and Lee Errett and Peterson, {Mark D.} and Subodh Verma and Randi Feder-Elituv and Gideon Cohen and Campbell Joyner and Fremes, {Stephen E.} and Fuad Moussa and George Christakis and Reena Karkhanis and Terry Yau and Michael Farkouh and Anna Woo and Cusimano, {Robert James} and Tirone David and Christopher Feindel and Lisa Garrard and Suzanne Fredericks and Amelia Mociornita and Mullen, {John C.} and Jonathan Choy and Steven Meyer and Emily Kuurstra and Young, {Cindi A.} and Dana Beach and Pavan Atluri and Woo, {Y. Joseph} and Mayer, {Mary Lou} and Michael Bowdish and Starnes, {Vaughn A.} and David Shavalle and Ray Matthews and Shadi Javadifar and Linda Romar and Kron, {Irving L.} and Karen Johnston and Dent, {John M.} and John Kern and Jessica Keim and Sandra Burks and Kim Gahring and Bull, {David A.} and Patrice Desvigne-Nickens and Dixon, {Dennis O.} and Mark Haigney and Richard Holubkov and Alice Jacobs and Frank Miller and Murkin, {John M.} and John Spertus and Wechsler, {Andrew S.} and Frank Sellke and McDonald, {Cheryl L.} and Robert Byington and Neal Dickert and Ikonomidis, {John S.} and Williams, {David O.} and Yancy, {Clyde W.} and Fang, {James C.} and Nadia Giannetti and Wayne Richenbacher and Vivek Rao and Furie, {Karen L.} and Rachel Miller and Sean Pinney and Roberts, {William C.} and Walsh, {Mary N.} and Keteyian, {Stephen J.} and Brawner, {Clinton A.} and Heather Aldred and Judy Hung and Xin Zeng and Jeffrey Browndyke and Yanne Toulgoat-Dubois",

note = "Publisher Copyright: {\textcopyright} 2019 The American Association for Thoracic Surgery",

year = "2020",

month = jun,

doi = "10.1016/j.jtcvs.2019.06.040",

language = "English",

volume = "159",

pages = "2230--2240.e15",

number = "6",

}

Ferket, BS, Thourani, VH, Voisine, P, Hohmann, SF, Chang, HL, Smith, PK, Michler, RE, Ailawadi, G, Perrault, LP, Miller, MA, O'Sullivan, K, Mick, SL, Bagiella, E, Acker, MA, Moquete, E, Hung, JW, Overbey, JR, Lala, A, Iraola, M, Gammie, JS, Gelijns, AC, O'Gara, PT, Moskowitz, AJ, Taddei-Peters, WC, Buxton, D, Caulder, R, Geller, NL, Gordon, D, Jeffries, NO, Lee, A, Moy, CS, Gombos, IK, Ralph, J, Weisel, R, Gardner, TJ, Rose, EA, Parides, MK, Ascheim, DD, Chang, H, Chase, M, Chen, Y, Goldfarb, S, Gupta, L, Kirkwood, K, Dobrev, E, Levitan, R, Overbey, J, Santos, M, Weglinski, M, Williams, P, Wood, C, Ye, X, Nielsen, SL, Wiggers, H, Malgaard, H, Mack, M, Adame, T, Settele, N, Adams, J, Ryan, W, Smith, RL, Grayburn, P, Chen, FY, Nohria, A, Cohn, L, Shekar, P, Aranki, S, Couper, G, Davidson, M, Bolman, RM, Burgess, A, Conboy, D, Noiseux, N, Stevens, LM, Prieto, I, Basile, F, Dionne, J, Fecteau, J, Blackstone, EH, Gillinov, AM, Lackner, P, Berroteran, L, Dolney, D, Fleming, S, Palumbo, R, Whitman, C, Sankovic, K, Sweeney, DK, Pattakos, G, Clarke, PA, Argenziano, M, Williams, M, Goldsmith, L, Smith, CR, Naka, Y, Stewart, A, Schwartz, A, Bell, D, Van Patten, D, Sreekanth, S, Alexander, JH, Milano, CA, Glower, DD, Mathew, JP, Harrison, JK, Welsh, S, Berry, MF, Parsa, CJ, Tong, BC, Williams, JB, Ferguson, TB, Kypson, AP, Rodriguez, E, Harris, M, Akers, B, O'Neal, A, Puskas, JD, Guyton, R, Baer, J, Baio, K, Neill, AA, Senechal, M, Dagenais, F, O'Connor, K, Dussault, G, Ballivian, T, Keilani, S, Speir, AM, Magee, P, Ad, N, Keyte, S, Dang, M, Slaughter, M, Headlee, M, Moody, H, Solankhi, N, Birks, E, Groh, MA, Shell, LE, Shepard, SA, Trichon, BH, Nanney, T, Hampton, LC, D'Alessandro, DA, DeRose, JJ, Goldstein, DJ, Bello, R, Jakobleff, W, Garcia, M, Taub, C, Spevak, D, Swayze, R, Basmadjian, AJ, Bouchard, D, Carrier, M, Cartier, R, Pellerin, M, Tanguay, JF, El-Hamamsy, I, Denault, A, Demers, P, Robichaud, S, Horvath, KA, Corcoran, PC, Siegenthaler, MP, Murphy, M, Greenberg, A, Sai-Sudhakar, C, Hasan, A, McDavid, A, Kinn, B, Pagé, P, Sirois, C, Latter, D, Leong-Poi, H, Bonneau, D, Errett, L, Peterson, MD, Verma, S, Feder-Elituv, R, Cohen, G, Joyner, C, Fremes, SE, Moussa, F, Christakis, G, Karkhanis, R, Yau, T, Farkouh, M, Woo, A, Cusimano, RJ, David, T, Feindel, C, Garrard, L, Fredericks, S, Mociornita, A, Mullen, JC, Choy, J, Meyer, S, Kuurstra, E, Young, CA, Beach, D, Atluri, P, Woo, YJ, Mayer, ML, Bowdish, M, Starnes, VA, Shavalle, D, Matthews, R, Javadifar, S, Romar, L, Kron, IL, Johnston, K, Dent, JM, Kern, J, Keim, J, Burks, S, Gahring, K, Bull, DA, Desvigne-Nickens, P, Dixon, DO, Haigney, M, Holubkov, R, Jacobs, A, Miller, F, Murkin, JM, Spertus, J, Wechsler, AS, Sellke, F, McDonald, CL, Byington, R, Dickert, N, Ikonomidis, JS, Williams, DO, Yancy, CW, Fang, JC, Giannetti, N, Richenbacher, W, Rao, V, Furie, KL, Miller, R, Pinney, S, Roberts, WC, Walsh, MN, Keteyian, SJ, Brawner, CA, Aldred, H, Hung, J, Zeng, X, Browndyke, J & Toulgoat-Dubois, Y 2020, 'Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation', Journal of Thoracic and Cardiovascular Surgery, vol. 159, no. 6, pp. 2230-2240.e15. https://doi.org/10.1016/j.jtcvs.2019.06.040

Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation. / Ferket, Bart S.; Thourani, Vinod H.; Voisine, Pierre et al.
In: Journal of Thoracic and Cardiovascular Surgery, Vol. 159, No. 6, 06.2020, p. 2230-2240.e15.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation

AU - Ferket, Bart S.

AU - Thourani, Vinod H.

AU - Voisine, Pierre

AU - Hohmann, Samuel F.

AU - Chang, Helena L.

AU - Smith, Peter K.

AU - Michler, Robert E.

AU - Ailawadi, Gorav

AU - Perrault, Louis P.

AU - Miller, Marissa A.

AU - O'Sullivan, Karen

AU - Mick, Stephanie L.

AU - Bagiella, Emilia

AU - Acker, Michael A.

AU - Moquete, Ellen

AU - Hung, Judy W.

AU - Overbey, Jessica R.

AU - Lala, Anuradha

AU - Iraola, Margaret

AU - Gammie, James S.

AU - Gelijns, Annetine C.

AU - O'Gara, Patrick T.

AU - Moskowitz, Alan J.

AU - Taddei-Peters, Wendy C.

AU - Buxton, Dennis

AU - Caulder, Ron

AU - Geller, Nancy L.

AU - Gordon, David

AU - Jeffries, Neal O.

AU - Lee, Albert

AU - Moy, Claudia S.

AU - Gombos, Ilana Kogan

AU - Ralph, Jennifer

AU - Weisel, Richard

AU - Gardner, Timothy J.

AU - Rose, Eric A.

AU - Parides, Michael K.

AU - Ascheim, Deborah D.

AU - Chang, Helena

AU - Chase, Melissa

AU - Chen, Yingchun

AU - Goldfarb, Seth

AU - Gupta, Lopa

AU - Kirkwood, Katherine

AU - Dobrev, Edlira

AU - Levitan, Ron

AU - Overbey, Jessica

AU - Santos, Milerva

AU - Weglinski, Michael

AU - Williams, Paula

AU - Wood, Carrie

AU - Ye, Xia

AU - Nielsen, Sten Lyager

AU - Wiggers, Henrik

AU - Malgaard, Henning

AU - Mack, Michael

AU - Adame, Tracine

AU - Settele, Natalie

AU - Adams, Jenny

AU - Ryan, William

AU - Smith, Robert L.

AU - Grayburn, Paul

AU - Chen, Frederick Y.

AU - Nohria, Anju

AU - Cohn, Lawrence

AU - Shekar, Prem

AU - Aranki, Sary

AU - Couper, Gregory

AU - Davidson, Michael

AU - Bolman, R. Morton

AU - Burgess, Anne

AU - Conboy, Debra

AU - Noiseux, Nicolas

AU - Stevens, Louis Mathieu

AU - Prieto, Ignacio

AU - Basile, Fadi

AU - Dionne, Joannie

AU - Fecteau, Julie

AU - Blackstone, Eugene H.

AU - Gillinov, A. Marc

AU - Lackner, Pamela

AU - Berroteran, Leoma

AU - Dolney, Diana

AU - Fleming, Suzanne

AU - Palumbo, Roberta

AU - Whitman, Christine

AU - Sankovic, Kathy

AU - Sweeney, Denise Kosty

AU - Pattakos, Gregory

AU - Clarke, Pamela A.

AU - Argenziano, Michael

AU - Williams, Mathew

AU - Goldsmith, Lyn

AU - Smith, Craig R.

AU - Naka, Yoshifumi

AU - Stewart, Allan

AU - Schwartz, Allan

AU - Bell, Daniel

AU - Van Patten, Danielle

AU - Sreekanth, Sowmya

AU - Alexander, John H.

AU - Milano, Carmelo A.

AU - Glower, Donald D.

AU - Mathew, Joseph P.

AU - Harrison, J. Kevin

AU - Welsh, Stacey

AU - Berry, Mark F.

AU - Parsa, Cyrus J.

AU - Tong, Betty C.

AU - Williams, Judson B.

AU - Ferguson, T. Bruce

AU - Kypson, Alan P.

AU - Rodriguez, Evelio

AU - Harris, Malissa

AU - Akers, Brenda

AU - O'Neal, Allison

AU - Puskas, John D.

AU - Guyton, Robert

AU - Baer, Jefferson

AU - Baio, Kim

AU - Neill, Alexis A.

AU - Senechal, Mario

AU - Dagenais, François

AU - O'Connor, Kim

AU - Dussault, Gladys

AU - Ballivian, Tatiana

AU - Keilani, Suzanne

AU - Speir, Alan M.

AU - Magee, Patrick

AU - Ad, Niv

AU - Keyte, Sally

AU - Dang, Minh

AU - Slaughter, Mark

AU - Headlee, Marsha

AU - Moody, Heather

AU - Solankhi, Naresh

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AU - Tanguay, Jean François

AU - El-Hamamsy, Ismail

AU - Denault, André

AU - Demers, Philippe

AU - Robichaud, Sophie

AU - Horvath, Keith A.

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AU - Murphy, Mandy

AU - Greenberg, Ann

AU - Sai-Sudhakar, Chittoor

AU - Hasan, Ayseha

AU - McDavid, Asia

AU - Kinn, Bradley

AU - Pagé, Pierre

AU - Sirois, Carole

AU - Latter, David

AU - Leong-Poi, Howard

AU - Bonneau, Daniel

AU - Errett, Lee

AU - Peterson, Mark D.

AU - Verma, Subodh

AU - Feder-Elituv, Randi

AU - Cohen, Gideon

AU - Joyner, Campbell

AU - Fremes, Stephen E.

AU - Moussa, Fuad

AU - Christakis, George

AU - Karkhanis, Reena

AU - Yau, Terry

AU - Farkouh, Michael

AU - Woo, Anna

AU - Cusimano, Robert James

AU - David, Tirone

AU - Feindel, Christopher

AU - Garrard, Lisa

AU - Fredericks, Suzanne

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AU - Mullen, John C.

AU - Choy, Jonathan

AU - Meyer, Steven

AU - Kuurstra, Emily

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AU - Atluri, Pavan

AU - Woo, Y. Joseph

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AU - Romar, Linda

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AU - Kern, John

AU - Keim, Jessica

AU - Burks, Sandra

AU - Gahring, Kim

AU - Bull, David A.

AU - Desvigne-Nickens, Patrice

AU - Dixon, Dennis O.

AU - Haigney, Mark

AU - Holubkov, Richard

AU - Jacobs, Alice

AU - Miller, Frank

AU - Murkin, John M.

AU - Spertus, John

AU - Wechsler, Andrew S.

AU - Sellke, Frank

AU - McDonald, Cheryl L.

AU - Byington, Robert

AU - Dickert, Neal

AU - Ikonomidis, John S.

AU - Williams, David O.

AU - Yancy, Clyde W.

AU - Fang, James C.

AU - Giannetti, Nadia

AU - Richenbacher, Wayne

AU - Rao, Vivek

AU - Furie, Karen L.

AU - Miller, Rachel

AU - Pinney, Sean

AU - Roberts, William C.

AU - Walsh, Mary N.

AU - Keteyian, Stephen J.

AU - Brawner, Clinton A.

AU - Aldred, Heather

AU - Hung, Judy

AU - Zeng, Xin

AU - Browndyke, Jeffrey

AU - Toulgoat-Dubois, Yanne

PY - 2020/6

Y1 - 2020/6

N2 - Objective: The Cardiothoracic Surgical Trials Network reported that left ventricular reverse remodeling at 2 years did not differ between patients with moderate ischemic mitral regurgitation randomized to coronary artery bypass grafting plus mitral valve repair (n = 150) or coronary artery bypass grafting alone (n = 151). To address health resource use implications, we compared costs and quality-adjusted survival. Methods: We used individual patient data from the Cardiothoracic Surgical Trials Network trial on survival, hospitalizations, quality of life, and US hospitalization costs to estimate cumulative costs and quality-adjusted life years. A microsimulation model was developed to extrapolate to 10 years. Bootstrap and deterministic sensitivity analyses were performed to address uncertainty. Results: In-hospital costs were $59,745 for coronary artery bypass grafting plus mitral valve repair versus $51,326 for coronary artery bypass grafting alone (difference $8419; 95% uncertainty interval, 2259-18,757). Two-year costs were $81,263 versus $67,341 (difference 13,922 [2370 to 28,888]), and quality-adjusted life years were 1.35 versus 1.30 (difference 0.05; −0.04 to 0.14), resulting in an incremental cost-effectiveness ratio of $308,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ($107,733 vs $88,583, difference 19,150 [−3866 to 56,826]) and quality-adjusted life years showed no difference (−0.92 to 0.87), with 5.08 versus 5.08. The likelihood that coronary artery bypass grafting plus mitral valve repair would be considered cost-effective at 10 years based on a cost-effectiveness threshold of $100K/quality-adjusted life year did not exceed 37%. Only when this procedure reduces the death rate by a relative 5% will the incremental cost-effectiveness ratio fall below $100K/quality-adjusted life year. Conclusions: The addition of mitral valve repair to coronary artery bypass grafting for patients with moderate ischemic mitral regurgitation is unlikely to be cost-effective. Only if late mortality benefits can be demonstrated will it meet commonly used cost-effectiveness criteria.

AB - Objective: The Cardiothoracic Surgical Trials Network reported that left ventricular reverse remodeling at 2 years did not differ between patients with moderate ischemic mitral regurgitation randomized to coronary artery bypass grafting plus mitral valve repair (n = 150) or coronary artery bypass grafting alone (n = 151). To address health resource use implications, we compared costs and quality-adjusted survival. Methods: We used individual patient data from the Cardiothoracic Surgical Trials Network trial on survival, hospitalizations, quality of life, and US hospitalization costs to estimate cumulative costs and quality-adjusted life years. A microsimulation model was developed to extrapolate to 10 years. Bootstrap and deterministic sensitivity analyses were performed to address uncertainty. Results: In-hospital costs were $59,745 for coronary artery bypass grafting plus mitral valve repair versus $51,326 for coronary artery bypass grafting alone (difference $8419; 95% uncertainty interval, 2259-18,757). Two-year costs were $81,263 versus $67,341 (difference 13,922 [2370 to 28,888]), and quality-adjusted life years were 1.35 versus 1.30 (difference 0.05; −0.04 to 0.14), resulting in an incremental cost-effectiveness ratio of $308,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ($107,733 vs $88,583, difference 19,150 [−3866 to 56,826]) and quality-adjusted life years showed no difference (−0.92 to 0.87), with 5.08 versus 5.08. The likelihood that coronary artery bypass grafting plus mitral valve repair would be considered cost-effective at 10 years based on a cost-effectiveness threshold of $100K/quality-adjusted life year did not exceed 37%. Only when this procedure reduces the death rate by a relative 5% will the incremental cost-effectiveness ratio fall below $100K/quality-adjusted life year. Conclusions: The addition of mitral valve repair to coronary artery bypass grafting for patients with moderate ischemic mitral regurgitation is unlikely to be cost-effective. Only if late mortality benefits can be demonstrated will it meet commonly used cost-effectiveness criteria.

KW - CABG

KW - Cardiothoracic Surgical Trials Network

KW - cost-effectiveness analysis

KW - health care costs

KW - ischemic mitral regurgitation

KW - mitral valve

KW - mitral valve repair

KW - quality-adjusted life years

UR - http://www.scopus.com/inward/record.url?scp=85069878953&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069878953&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2019.06.040

DO - 10.1016/j.jtcvs.2019.06.040

M3 - Article

C2 - 31375378

AN - SCOPUS:85069878953

SN - 0022-5223

VL - 159

SP - 2230-2240.e15

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

IS - 6

ER -

Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation

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