Presentation (CTI)

OBJECTIVES: This analysis relies on prior research and cost projections for key health outcomes to estimate the long-run costs associated with SMVR for patients receiving a novel tissue mitral valve relative to a mitral mechanical valve replacement.
METHODS: This economic evaluation generally follows CHEERS methodology promulgated by ISPOR and relies on prior epidemiologic and costs studies to serve as inputs in deterministic and Monte Carlo simulation models. With respect to epidemiological model inputs, the model uses A) the long-run incidence of key health outcomes in patients undergoing surgical mitral valve replacement (SMVR) with legacy tissue valves, B) the relative risk or hazard rate of these outcomes for patients receiving mechanical valves (in relation to tissue valves) and C) the improved reoperation profile of novel tissue valves. In addition to mortality, key outcomes tracked over extended periods include reoperation, bleeding, thromboembolism and endocarditis. The model also accounts for anti-coagulant monitoring (ACM) which is generally required in perpetuity for mechanical valve patients, but for 3-6 months (conditional on no atrial fibrillation) in tissue valve patients.
RESULTS: In the base case analysis, 5-year per patient cost savings for a novel mitral tissue valve replacement relative to a mechanical valve replacement were estimated at $9,185 (95% CI: $6,159-$12,752). At 15 years, expected savings range from $14,785 to $23,349 depending on the durability of lower re-operative risk (relative to legacy tissue valves) after five years. If the analysis is extended to 25 years expected savings range from $15,899 to $30,665.
CONCLUSIONS: Over the long run, future expected costs associated with mitral valve replacement are lower in patients that rely on novel tissue valves relative to mechanical valves.