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Impact of updated trial data on the cost-effectiveness of percutaneous mitral repair
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Connock, Martin, Auguste, Peter, Obadia, Jean-François, Andronis, Lazaros and Armoiry, Xavier (2023) Impact of updated trial data on the cost-effectiveness of percutaneous mitral repair. PLoS One, 18 (1). e0280554. doi:10.1371/journal.pone.0280554 ISSN 1932-6203.
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WRAP-Impact-of-updated-trial-data-on-the-cost-effectiveness-of-percutaneous-mitral-repair-Andronis-2023.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1930Kb) | Preview |
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WRAP-Impact-of-updated-trial-data-on-the-cost-effectiveness-of-percutaneous-mitral-repair-Andronis-2023.pdf - Accepted Version Embargoed item. Restricted access to Repository staff only - Requires a PDF viewer. Download (346Kb) |
Official URL: https://doi.org/10.1371/journal.pone.0280554
Abstract
When updated clinical trial data becomes available reassessing the cost-effectiveness of technologies may modify estimates and influence decision-making. We investigated the impact of updated trial outcomes on the cost-effectiveness of percutaneous mitral repair (PR) for secondary mitral regurgitation. We updated our previous three-state time-varying Markov model to assess the cost-effectiveness of PR + guideline directed medical treatment (GDMT) versus GDMT alone. Key clinical inputs (overall survival (OS) and heart failure hospitalisations (HFH)) were obtained using the 3-year trial findings from the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy) RCT. We calculated incremental cost-effectiveness ratios (ICER) and report how these differ between analyses based on early (2-year) and updated (3-year) evidence. Updated trial data showed an increase in mortality in the intervention arm between two and three years follow-up that was not seen in the control arm. Deterministic and multivariate cost-effectiveness modelling yielded incremental cost effectiveness ratios ICERs of €38,123 and €31,227 /QALY. Compared to our 2-year based estimate (€21,918 / QALY) these results imply an approximate 1.5-fold increase in ICER. The availability of updated survival analyses from the COAPT pivotal trial suggests previous estimates based on 2-year trial findings were over optimistic for the intervention.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
| Library of Congress Subject Headings (LCSH): | Mitral valve -- Diseases, Mitral valve insufficiency, Heart failure -- Treatment | ||||||
| Journal or Publication Title: | PLoS One | ||||||
| Publisher: | Public Library of Science | ||||||
| ISSN: | 1932-6203 | ||||||
| Official Date: | 26 January 2023 | ||||||
| Dates: |
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| Volume: | 18 | ||||||
| Number: | 1 | ||||||
| Article Number: | e0280554 | ||||||
| DOI: | 10.1371/journal.pone.0280554 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 16 January 2023 | ||||||
| Date of first compliant Open Access: | 16 January 2023 |
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