Presentation (CTI)

OBJECTIVES: Degenerative mitral valve regurgitation is commonly treated through conventional sternotomy (CS). Robotic-assisted mitral valve repair (RAMVR) has emerged as a minimally invasive alternative associated with improved perioperative outcomes and faster recovery, but its adoption remains limited by higher costs. This study evaluated the cost-effectiveness of RAMVR versus CS from a US hospital provider perspective.
METHODS: A cost-effectiveness model compared RAMVR and CS over a one-year horizon. Clinical probabilities were obtained from contemporary meta-analyses and registry studies, while costs were estimated in 2025 US dollars from National Inpatient Sample data and published economic evaluations. Outcomes were measured as quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICERs) were calculated and evaluated against a willingness-to-pay threshold of $50,000/QALY. Uncertainty was assessed using probabilistic sensitivity analysis with 5,000 Monte Carlo simulations.
RESULTS: RAMVR was associated with an expected cost of $23,450 and 0.914 QALYs versus $20,600 and 0.806 QALYs for CS. The robotic strategy generated an incremental cost of $2,850 and a gain of 0.108 QALYs, resulting in an ICER of $26,292/QALY gained. Threshold analysis showed RAMVR remained cost-effective if robotic consumable costs did not exceed $6,070 per procedure. Probabilistic sensitivity analysis demonstrated a 79.94% probability of cost-effectiveness at the $50,000/QALY threshold.
CONCLUSIONS: RAMVR is a cost-effective alternative to CS for degenerative mitral valve regurgitation, particularly in high-volume centers. Despite higher upfront costs, these are offset by lower postoperative resource use, shorter hospital stays, fewer complications, and improved quality of life, supporting the value of robotic mitral valve repair in contemporary cardiovascular care.