E-viri
PDF
Recenzirano
Odprti dostop
-
Michler, Robert E.; Ailawadi, Gorav; Perrault, Louis P.; Miller, Marissa A.; O'Sullivan, Karen; Hung, Judy W.; Overbey, Jessica R.; Iraola, Margaret; Gelijns, Annetine C.; Moskowitz, Alan J.; Miller, Marissa A.; Taddei-Peters, Wendy C.; Geller, Nancy L.; Lee, Albert; Gelijns, Annetine C.; Ascheim, Deborah D.; Moskowitz, Alan J.; Bagiella, Emilia; Moquete, Ellen; Chang, Helena; Chen, Yingchun; Goldfarb, Seth; Gupta, Lopa; O'Sullivan, Karen; Santos, Milerva; Weglinski, Michael; Williams, Paula; Wiggers, Henrik; Adame, Tracine; Ryan, William; Grayburn, Paul; Chen, Frederick Y.; Aranki, Sary; Davidson, Michael; Prieto, Ignacio; Dionne, Joannie; Lackner, Pamela; Berroteran, Leoma; Smith, Craig R.; Naka, Yoshifumi; Stewart, Allan; Van Patten, Danielle; Alexander, John H.; Mathew, Joseph P.; Parsa, Cyrus J.; Tong, Betty C.; Ferguson, T. Bruce; Akers, Brenda; Puskas, John D.; Baio, Kim; Speir, Alan M.; Magee, Patrick; Keyte, Sally; Dang, Minh; Slaughter, Mark; Headlee, Marsha; Moody, Heather; Birks, Emma; Shepard, Stephanie A.; Nanney, Tracy; Hampton, Lynne C.; DeRose, Joseph J.; Taub, Cynthia; Perrault, Louis P.; Basmadjian, Arsène-Joseph; Bouchard, Denis; Carrier, Michel; Tanguay, Jean François; El-Hamamsy, Ismail; Robichaud, Sophie; Corcoran, Philip C.; Hasan, Ayseha; McDavid, Asia; Peterson, Mark D.; Cohen, Gideon; Moussa, Fuad; Christakis, George; David, Tirone; Garrard, Lisa; Meyer, Steven; Kuurstra, Emily; Dent, John M.; Kern, John; Dixon, Dennis O.; Haigney, Mark; Holubkov, Richard; Jacobs, Alice; Murkin, John M.; Spertus, John; McDonald, Cheryl L.; Williams, David O.; Richenbacher, Wayne; Rao, Vivek; Miller, Rachel; Pinney, Sean; Roberts, William C.; Walsh, Mary N.; Keteyian, Stephen J.; Aldred, Heather; Browndyke, Jeffrey
The Journal of thoracic and cardiovascular surgery, June 2020, 2020-Jun, 2020-06-00, 20200601, Letnik: 159, Številka: 6Journal Article
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. 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. 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. 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.
