{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:37:20Z","timestamp":1791247040636,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2019,12,3]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>The COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) demonstrated that edge-to-edge transcatheter mitral valve repair (TMVr) with the MitraClip resulted in reduced mortality and heart failure hospitalizations and improved quality of life compared with maximally tolerated guideline-directed medical therapy (GDMT) in patients with heart failure and 3 to 4+ secondary mitral regurgitation. Whether TMVr is cost-effective compared with GDMT in this population is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We used data from the COAPT trial to perform a formal patient-level economic analysis of TMVr+GDMT versus GDMT alone for patients with heart failure and 3 to 4+ secondary mitral regurgitation from the perspective of the US healthcare system. Costs for the index TMVr hospitalization were assessed using a combination of resource-based accounting and hospital billing data (when available). Follow-up medical care costs were estimated on the basis of medical resource use collected during the COAPT trial. Health utilities were estimated for all patients at baseline and 1, 6, 12, and 24 months with the Short Form Six-Dimension Health Survey.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Initial costs for the TMVr procedure and index hospitalization were $35\u2009755 and $48\u2009198, respectively. Although follow-up costs were significantly lower with TMVr compared with GDMT ($26\u2009654 versus $38\u2009345;\n              <jats:italic>P<\/jats:italic>\n              =0.018), cumulative 2-year costs remained higher with TMVr because of the upfront cost of the index procedure ($73\u2009416 versus $38\u2009345;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). When in-trial survival, health utilities, and costs were modeled over a lifetime horizon, TMVr was projected to increase life expectancy by 1.13 years and quality-adjusted life-years by 0.82 years at a cost of $45\u2009648, yielding a lifetime incremental cost-effectiveness ratio of $40\u2009361 per life-year gained and $55\u2009600 per quality-adjusted life-year gained.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>For symptomatic patients with heart failure and 3 to 4+ secondary mitral regurgitation, TMVr increases life expectancy and quality-adjusted life expectancy compared with GDMT at an incremental cost per quality-adjusted life-year gained that represents acceptable economic value according to current US thresholds.<\/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: NCT01626079.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.119.043275","type":"journal-article","created":{"date-parts":[[2019,9,29]],"date-time":"2019-09-29T15:45:45Z","timestamp":1569771945000},"page":"1881-1891","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":68,"title":["Cost-Effectiveness of Transcatheter Mitral Valve Repair Versus Medical Therapy in Patients With Heart Failure and Secondary Mitral Regurgitation"],"prefix":"10.1161","volume":"140","author":[{"given":"Suzanne J.","family":"Baron","sequence":"first","affiliation":[{"name":"Lahey Hospital and Medical Center, Burlington, MA (S.J.B.)."},{"name":"Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (S.J.B., K.W., S.V.A., E.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaijun","family":"Wang","sequence":"additional","affiliation":[{"name":"Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (S.J.B., K.W., S.V.A., E.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne V.","family":"Arnold","sequence":"additional","affiliation":[{"name":"Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (S.J.B., K.W., S.V.A., E.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Magnuson","sequence":"additional","affiliation":[{"name":"Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (S.J.B., K.W., S.V.A., E.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Whisenant","sequence":"additional","affiliation":[{"name":"Intermountain Heart Institute, Salt Lake City, UT (B.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Brieke","sequence":"additional","affiliation":[{"name":"University of Colorado Hospital, Aurora (A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC (M.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita W.","family":"Asgar","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute, QC, Canada (A.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joann","family":"Lindenfeld","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, TN (J.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Abraham","sequence":"additional","affiliation":[{"name":"Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Mack","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Healthcare, Plano, TX (M.J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg W.","family":"Stone","sequence":"additional","affiliation":[{"name":"Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cohen","sequence":"additional","affiliation":[{"name":"University of Missouri\u2013Kansas City (D.J.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the COAPT Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2017.06.015"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/echo.13690"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.09.073"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000503"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1806640"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2017.2976"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.054072"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.10.046"},{"key":"e_1_3_3_10_2","unstructured":"MedPAR Inpatient Hospital National Data for Fiscal Year 2016: Short Stay Inpatient by DRG. 2018. https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-reports\/MedicareFeeforSvcPartsAB\/Downloads\/DRG16.pdf.Accessed October 2 2018."},{"key":"e_1_3_3_11_2","unstructured":"RED BOOK Online. 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