Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings

Borisenko, Oleg; Haude, Michael; Hoppe, Uta C; Siminiak, Tomasz; Lipiecki, Janusz; Goldberg, Steve L; Mehta, Nawzer; Bouknight, Omari V; Bjessmo, Staffan; Reuter, David G

doi:10.1186/s12872-015-0039-8

Table 2 Clinical, cost and utility inputs

From: Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings

Variable	Base Case Value	Range	Distribution for probabilistic sensitivity analysis	Reference
Characteristics of patients’ population
Age, years	62	50–80	Normal	[13]
			(SD =12)
Male gender, %	77	0–100	Beta
Proportion of patients with severe MR at baseline in both arms	0.639	0.511–0.766	Beta
			(α = 23; β = 13)
Proportion of patients with severe MR between 1 and 5 months in PMVR arm	0.35	0.28–0.42	Beta
			(α = 12; β = 22)
Proportion of patients with severe MR from 6 months and onwards in PMVR arm	0.258	0.206–0.309	Beta
			(α = 8; β = 23)
Effectiveness data and transition probabilities
Probability of peri-procedural mortality	0.019	0.01–0.03	Beta	[13]
			(α = 1; β = 52)
Probability of myocardial infarction, which leads to PCI	0.04	0.02–0.06	Beta
			(α = 2; β = 51)
Probability of vessel perforation	0.02	0–0.03	Beta
			(α = 1; β = 52)
Probability of unsuccessful percutaneous annuloplasty	0.32	0.05–0.40	Beta
			(α = 17; β = 36)
Probability of arrhythmia	0.04	0.02–0.06	Beta	Assumption
			(α = 2; β = 51)
Six-month probability of excess mortality for NYHA class II	0.04	0.02–0.06	Beta	[22]
			(α = 4; β = 96)
Six-month probability of excess mortality for NYHA class III	0.07	0.035–0.105	Beta
			(α = 7; β = 93)
Six-month probability of excess mortality for NYHA class IV	0.28	0.14–0.42	Beta
			(α = 28; β = 72)
Monthly probability of hospitalization for NYHA class I	0.015	0.008–0.023	Beta	[21]
			(α = 1.5; β = 98.5)
Monthly probability of hospitalization for NYHA class II	0.024	0.012–0.036	Beta
			(α = 2.4; β = 97.6)
Monthly probability of hospitalization for NYHA class III	0.024	0.012–0.036	Beta
			(α = 2.4; β = 97.6)
Monthly probability of hospitalization for NYHA class IV	0.154	0.077–0.231	Beta
			(α = 15.4; β = 84.6)
Relative risk for all-cause mortality with present severe MR	1.5	1.1–1.9	Log-normal (SE_log = 0.26)	[23]
Relative risk for hospitalization due to HF with present severe MR	1.7	1.3–2.1	Log-normal (SE_log = 0.33)
Resource utilization and cost data
Cost of Carillon device, €	18,000	12,600–23,400	-	Cardiac Dimensions, Inc.
Cost of PMVR placement procedure, €	4844	3391–6297	-	G-DRG code F19C
Cost of treatment of vessel perforation after PMVR placement, €	1998	1399–2597	-
Percentage of patients being hospitalized with stay in intensive care unit	7.2 %	-	Dirichlet	[27]
Percentage of patients being hospitalized with stay in coronary care unit	25.6 %	-
Percentage of patients being hospitalized with CABG performed	0.3 %	-
Percentage of patients being hospitalized with PTCA performed	0.2 %	-
Percentage of patients being hospitalized with heart transplantation performed	2.6 %	-
Percentage of patients being hospitalized with no procedure performed	62.3 %	-
Cost of hospitalization with stay in intensive care unit, €	5004	3503–6506	-	G-DRG code F62A 2013
Cost of hospitalization with stay in coronary care unit, €	5004	3503–6506	-	G-DRG code F62A 2013
Cost of hospitalization with CABG performed, €	15,056	10,539–19,573	-	G-DRG code F06E
Cost of hospitalization with PTCA performed, €	3793	2655–4931	-	G-DRG code F56B plus ZE101
Cost of hospitalization with heart transplantation performed, €	86,337	60,436–112,239	-	G-DRG code A05B 2013
Cost of hospitalization with no procedure performed, €	2740	1918–3562	-	G-DRG code F62B 2013
Annual cost of routine management of heart failure in NYHA class I, €	495	258–1031	Gamma	[26]
			(α = 1;λ = 516)
Annual cost of routine management of heart failure in NYHA class II, €	874	455–1821	Gamma
			(α = 1;λ = 910)
Annual cost of routine management of heart failure in NYHA class III, €	864	450–1800	Gamma
			(α = 1;λ = 900)
Annual cost of routine management of heart failure in NYHA class IV, €	929	484–1935	Gamma
			(α = 1;λ = 967)
Utility data
Utility for NYHA I class	0.815	0.652–0.978	Beta	[27]
			(α = 395; β = 90)
Utility for NYHA II class	0.720	0.576–0.864	Beta
			(α = 662; β = 257)
Utility for NYHA III class	0.590	0.472–0.708	Beta
			(α = 360; β = 250)
Utility for NYHA IV class	0.508	0.406–0.609	Beta (α = 52; β = 50)
Decrement for percutaneous annuloplasty procedure	0.043	0.034–0.051	Beta	[29]
			(α = 96; β = 2129)

SD, standard deviation; MR, mitral regurgitation; PMVR, percutaneous mitral valve repair; NYHA, New York Heart Association

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