{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:26:07Z","timestamp":1789500367273,"version":"build-2803163510"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The CTSN (Cardiothoracic Surgical Trials Network) recently reported no difference in left ventricular end-systolic volume index or in survival at 2 years between patients with severe ischemic mitral regurgitation (MR) randomized to mitral valve repair or replacement. However, replacement provided more durable correction of MR and fewer cardiovascular readmissions. Yet, cost-effectiveness outcomes have not been addressed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>We conducted a cost-effectiveness analysis of the surgical treatment of ischemic MR based on the CTSN trial (n=126 for repair; n=125 for replacement). Patient-level data on readmissions, survival, quality-of-life, and US hospital costs were used to estimate costs and quality-adjusted life years per patient over the trial duration and a 10-year time horizon. We performed microsimulation for extrapolation of outcomes beyond the 2 years of trial data. Bootstrap and deterministic sensitivity analyses were done to address parameter uncertainty. In-hospital cost estimates were $78 216 for replacement versus $72 761 for repair (difference: $5455; 95% uncertainty interval [UI]: \u22127784\u201321 193) while 2-year costs were $97 427 versus $96 261 (difference: $1166; 95% UI: \u221216 253\u201317 172), respectively. Quality-adjusted life years at 2 years were 1.18 for replacement versus 1.23 for repair (difference: \u22120.05; 95% UI: \u22120.17 to 0.07). Over 5 and 10 years, the benefits of reduction in cardiovascular readmission rates with replacement increased, and survival minimally improved compared with repair. At 5 years, cumulative costs and quality-adjusted life years showed no difference on average, but by 10 years, there was a small, uncertain benefit for replacement: $118 023 versus $119 837 (difference: \u2212$1814; 95% UI: \u221227 144 to 22 602) and quality-adjusted life years: 4.06 versus 3.97 (difference: 0.09; 95% UI: \u22120.87 to 1.08). After 10 years, the incremental cost-effectiveness of replacement continued to improve.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Our cost-effectiveness analysis predicts potential savings in cost and gains in quality-adjusted survival at 10 years when mitral valve replacement is compared with repair for severe ischemic MR. These projected benefits, however, were small and subject to variability. Efforts to further delineate predictors of long-term outcomes in patients with severe ischemic MR are needed to optimize surgical decisions for individual patients, which should yield more cost-effective care.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CLINICAL TRIAL REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT00807040.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.117.004466","type":"journal-article","created":{"date-parts":[[2019,1,7]],"date-time":"2019-01-07T16:57:58Z","timestamp":1546880278000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Cost-Effectiveness of Mitral Valve Repair Versus Replacement for Severe Ischemic Mitral Regurgitation"],"prefix":"10.1161","volume":"11","author":[{"given":"Bart S.","family":"Ferket","sequence":"first","affiliation":[{"name":"International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gorav","family":"Ailawadi","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville (G.A.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annetine C.","family":"Gelijns","sequence":"additional","affiliation":[{"name":"International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Acker","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia (M.A.A.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel F.","family":"Hohmann","sequence":"additional","affiliation":[{"name":"Center for Advanced Analytics, Vizient, Chicago, IL (S.F.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena L.","family":"Chang","sequence":"additional","affiliation":[{"name":"International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Bouchard","sequence":"additional","affiliation":[{"name":"Montr\u00e9al Heart Institute, University of Montr\u00e9al, QC, Canada (D.B.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Meltzer","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Chicago, IL (D.O.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Michler","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, Department of Surgery, Montefiore Medical Center\/Albert Einstein College of Medicine, New York, NY (R.E.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen G.","family":"Moquete","sequence":"additional","affiliation":[{"name":"International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Voisine","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie de Qu\u00e9bec, H\u00f4pital Laval, Canada (P.V.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Mullen","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of Alberta, Edmonton, Canada (J.C.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuradha","family":"Lala","sequence":"additional","affiliation":[{"name":"International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Mack","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott &amp; White Health, Plano, TX (M.J.M., R.L.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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