Real-world cost effectiveness of MitraClip combined with medical therapy versus medical therapy alone in patients with moderate or severe mitral regurgitation

Background:Weevaluated the real-world cost-effectiveness of theMitraClip system (Abbott Vascular Inc., Menlo Park, CA) plusmedical therapy for patientswithmoderate/severe mitral regurgitation, as comparedwithmedical therapy (MT) alone. Methods: Clinical records of patients with moderate to severe functional mitral regurgitation treated with MitraClip (N=232) or with MT (N=151) were collected and outcome analyzed with propensity score adjustment to reduce selection bias. Twelve-month outcomes were modeled over a lifetime horizon to conduct a costeffectiveness analysis, in the payer's perspective. Costs and benefits were discounted at an annual rate of 3.5%. Results: After propensity score adjustment, the average treatment effect was −9.5% probability of dying at 12 months and, following lifetime modeling, 3.35 ± 0.75 incremental life years and 3.01 ± 0.57 incremental quality-adjusted life years. MitraClip contributed to a higher decrease in re-hospitalizations at 12 months (difference = −0.54 ± 0.08) and generated a more likely improvement in the New York Heart Association (NYHA) class at 12 months versus NYHA at enrollment. Incremental costs, adapted to five possible scenarios, ranged from 14,493 to 29,795 € contributing to an incremental cost-effectiveness ratio ranging from 4796 to 7908 €. Conclusions: Compared toMT alone and given conventional threshold values, MitraClip can be considered a costeffective procedure. The cost-effectiveness of MitraClip is in line or superior to the one of other nonpharmaceutical strategies for heart failure.