Real-world cost-effectiveness of the mitraclip for the treatment of high risk mitral regurgitation

Mitral regurgitation (MR), a cardiac disease resulting in volume overload, is associated with an increased risk of heart failure and mortality. Standard care for MR is surgical repair or replacement of the mitral valve. Patients at high risk for surgical intervention, such as those with functional MR, are often relegated to medical management alone. The MitraClip is a transcatheter device, which performs percutaneous edge-to-edge repair to treat MR. We, evaluated the real-world clinical and cost effectiveness of MitraClip in high-risk MR patients. Data for patients receiving MitraClip were obtained from a prospective registry of high-risk MR patients treated at the Montreal Heart Institute (MHI) in Quebec from December 2010 to May 2013. These patients were propensity matched on baseline characteristics and medical therapy to medically treated MR patients followed at the MHI Heart Failure Clinic from 2008 to 2011. Cohorts were compared on clinical and economic outcomes, quality of life (QoL), complications/adverse events, emergency room (ER) visits, hospitalizations, surgical intervention, and clinic visits. Based on data from this matched comparison, we then developed a decision analytic model to assess the incremental cost-effectiveness of MitraClip vs. medical therapy in patients with high-risk MR. Survival for each group was extrapolated beyond follow-up to 10 years using Weibull regression. Unit costs were obtained from the MHI. Costs and benefits were discounted at 5% per annum. One-way and probabilistic sensitivity analyses were performed. Compared with medical therapy, treatment with MitraClip was associated with a gain of 1.34 quality-adjusted life years (QALYs) and an incremental cost of $48,970 (Canadian). The incremental cost-effectiveness ratio (ICER) was $36,543 per QALY gained. Based on data from our matched, observational comparison, treatment with the MitraClip appears to be an economically attractive alternative to medical therapy for high-risk patients with MR.