AUTHOR=Xia Wengang , Han Kangning , Lou Yake 

TITLE=MitraClip for the treatment of heart failure with mitral regurgitation: A cost-effectiveness analysis in a Chinese setting

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.970118

DOI=10.3389/fcvm.2022.970118

ISSN=2297-055X

ABSTRACT=Background: Heart failure with mitral regurgitation is associated with decreased survival. Guideline-directed medical therapy and transcatheter edge-to-edge repair (TEER) are the main 
options for HF patients with severe mitral regurgitation who are considered high-risk or prohibitive.
There is no study investigating the cost-effectiveness of MitraClip versus optimal medical therapy 
in China setting.
Methods: A combined decision tree and Markov model were developed to compare the cost-effectiveness MitraClip versus optimal medical therapy with a lifetime simulation. The primary 
outcome was the incremental cost-effectiveness ratio (ICER), which represented incremental costs 
per quality-adjusted life-year (QALY). The willingness-to-pay (WTP) threshold was set three times 
of per capita GDP in China in 2021, which was 242,928 CNY. MitraClip would be considered cost-effective if the ICER obtained was lower than the WTP threshold, otherwise, it would be thought 
not cost-effective. One-way sensitivity and probabilistic sensitivity analysis were performed to 
validate the robustness of the results.
Results: After a simulation of lifetime, the overall cost for a patient in MitraClip cohort was 423,817 
CNY, and the lifetime cost in OMT was 28,369 CNY. The corresponding effectiveness in both 
cohorts were 2.32 QALY and 1.80 QALY per person, seperately. The incremental cost and increment 
effectiveness was 395,448 CNY and 0.52 QALY, the ICER was 754,410 CNY/QALY. The ICER
obtained was higher than the WTP threshold. Sensitivity analysis validated our finding.
Conclusion: MitraClip resulted in more effectiveness but with more cost compared with optimal 
medical therapy, and the incremental cost-effectiveness ratio obtained was higher than the 
willingness-to-pay threshold. MitraClip is considered not cost-effective in Chinese heart failure 
patients with secondary mitral regurgitation.