The COAPT Economic Analysis sub-study found it is cost effective to treat heart failure patients who have severe secondary mitral regurgitation with MitraClip to reduce their MR symptoms.
October 4, 2019 – Results of a new economic analysis of the COAPT Trial data found that transcatheter mitral valve replacement (TMVR) combined with guideline-directed medical therapy (GDMT) is a cost-effective treatment strategy for patients with heart failure and severe secondary mitral regurgitation (MR). Findings were reported today at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. The results were also published simultaneously in Circulation.
“The cost-effectiveness of TMVR for the COAPT population is comparable to that of other commonly used technologies for the treatment of heart failure, including implantable cardiac defibrillators, and is substantially more cost-effective than the use of continuous-flow left ventricular assist devices for destination therapy,” said Suzanne J. Baron, M.D., MSc, director of ionterventional cardiology research at Lahey Hospital and Medical Center in Burlington, Mass. “Together with the improved clinical outcomes in the COAPT trial, these findings suggest that TMVR is a reasonable treatment strategy for this patient population based on both clinical and economic considerations.”
Two-year data from the randomized COAPT trial found that patients with heart failure and secondary mitral regurgitation who remained symptomatic despite maximally tolerated medical therapy demonstrated reduced rates of hospitalizations and death, as well as improved quality-of-life and functional capacity after being treated with the transcatheter MitraClip device. These results were first reported at TCT 2018 and published in the New England Journal of Medicine.
Using data from the COAPT Trial, researchers performed a formal, patient-level economic analysis of TMVR with GDMT versus GDMT alone in patients with heart failure with moderate-to-severe or severe secondary MR from the perspective of the United States healthcare system. Observed in-trial data were used to project long-term patient-level survival, health utilities (a measure of quality of life), and costs.
The analysis found that, although follow-up costs were approximately $11,000 per patient lower with TMVR with GDMT compared with GDMT alone ($26,654 vs. $38,345; p=0.018), cumulative two-year costs remained substantially higher with TMVR due to the up-front cost of the index procedure ($73,416 vs. $38,345; p<0.001). When in-trial survival, health utilities, and costs were modeled over a lifetime horizon, TMVR was projected to increase quality-adjusted life-years (QALYs) by 0.82 years at a cost of $45,648, yielding a lifetime incremental cost-effectiveness ratio (ICER) of $55,600/QALY gained. In the United States, an ICER less than $50,000/QALY gained is considered high value, while an ICER less than $150,000/QALY gained is considered to be of intermediate value. The results remained consistent across a variety of sensitivity and subgroup analyses.
The COAPT study was funded by Abbott. Baron disclosed research funding and advisory board compensation from Boston Scientific Corp. and consulting fees from Edwards Lifesciences.
Related COAPT Content:
COAPT Three-year Data Show Continued Effectiveness in Heart Failure Patients - second presentation at TCT 2019
VIDEO: MitraClip to Treat Heart Failure - Results of the COAPT Trial — Interview with William Abraham, M.D.,
VIDEO: Echocardiographic Findings in the COAPT Trial — Interview with Federico Asch, M.D.
VIDEO: Impact of the COAPT Trial on Heart Failure Patients With Functional Mitral Regurgitation — Interview with Andreas Brieke, M.D.
1. Suzanne J. Baron, Kaijun Wang, Suzanne V. Arnold, et al. Cost-Effectiveness of Transcatheter Mitral Valve Repair versus Medical Therapy in Patients with Heart Failure and Secondary Mitral Regurgitation: Results from the COAPT Trial. Circulation. Originally published online 29 Sep 2019. https://doi.org/10.1161/CIRCULATIONAHA.119.043275Circulation.
2. Gregg W. Stone, JoAnn Lindenfeld, William T. Abraham, et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med 2018; 379:2307-2318. December 13, 2018. DOI: 10.1056/NEJMoa1806640