OBJECTIVES: To quantify patient preferences for risk-benefit tradeoffs for transcatheter and surgical procedure options for mitral regurgitation (MR).

METHODS: A discrete-choice experiment (DCE) survey was designed and administered online to patients with MR recruited in partnership with a patient advocacy organization. Attributes (and levels) included: procedure type (transcatheter versus surgical); risk of 30-day mortality (2%, 5%, and 10%); risk of five-year mortality (20%, 30%, and 45%) and physical functioning for five years (corresponding to improvements from New York Heart Association [NYHA] class III to I or class III to II); number of hospitalizations (1, 4, and 8) over five years; and risk of additional surgery over five years (10%, 20%, and 30% or 40%). A mixed-logit regression model was fit to estimate preference weights.

RESULTS: 201 individuals completed the survey: 63% were female; mean age was 74 years. On average, respondents preferred a transcather procedure over surgery. To undergo a less invasive procedure (transcatheter), respondents in the next five years would accept up to a 13.3% (95% confidence interval [CI]: 8.7% to 18.5%) increase in risk of surgery above a baseline risk of 10%, 4.6 (95% CI: 3.1 to 6.2) more hospitalizations above a baseline of one hospitalization, a 9.3% (95% CI: 5.2% to 14.3%) increase in risk of death above a baseline risk of 20%, or more limited physical functioning representing an equivalent of nearly one NYHA class (0.8, 95% CI: 0.5 to 1.3). Conversely, respondents would undergo surgery if five-year gains in physical functioning were equivalent to achieving NYHA class I versus NYHA class II (from a baseline of NYHA class III).

CONCLUSIONS: Patients in general preferred a transcatheter procedure over surgery to the extent that they would accept a higher 5-year mortality risk, a higher risk of 5-year reintervention, or lesser levels of improvement in physical functioning.