# Cost-Effectiveness of Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement for Degenerated Bioprosthetic Mitral Valve

## TL;DR

Valve-in-valve transcatheter mitral valve replacement is less costly and more effective than redo surgery for treating failed bioprosthetic valves.

## Contribution

A decision-analytic model demonstrates that ViV TMVR is a dominant and cost-effective treatment option for degenerated bioprosthetic mitral valves.

## Key findings

- ViV TMVR was less costly and more effective than redo-SMVR at 1 month.
- ViV TMVR was cost-effective in 83%–88% of simulations for willingness-to-pay thresholds up to $100,000.
- Cost-effectiveness was primarily influenced by shorter hospital stays and lower valve/device costs.

## Abstract

Degenerated bioprosthetic mitral valves (MVs) are associated with significant morbidity and health care expenditures. For certain patients, valve-in-valve transcatheter MV replacement (ViV TMVR) has emerged as a promising treatment option due to fewer complications and shorter hospital length of stay when compared with redo surgical MV replacement (redo-SMVR). We constructed a decision-analytic model comparing the cost-effectiveness of ViV TMVR to redo-SMVR for the management of degenerated bioprosthetic valves.

Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. The main outcome was ICERs defined as United States (US) dollars/deaths averted.

In the base case analysis, the cost associated with ViV TMVR was estimated at $87,724 with a 0.93 probability of survival at 1 month. For the redo-SMVR strategy, the cost was $104,444, and the probability of survival at 1 month was 0.89. Overall, ViV TMVR resulted in savings of $418,001 per death averted (ICER, −$418,001/death averted). In cost-effectiveness acceptability curves, ViV TMVR was cost-effective in 83% to 88% of simulations for a willingness-to-pay threshold ranging from $0 to $100,000.

ViV TMVR is an effective strategy that may result in significant health care savings for the management of degenerated bioprosthetic valves.

•Decision model compared valve-in-valve transcatheter mitral valve replacement (ViV TMVR) vs. redo-surgical mitral valve replacement for failed bioprosthetic mitral valve.•At 1 month, ViV TMVR was less costly and more effective (dominant).•ViV TMVR was cost-effective in 83%–88% of simulations across willingness-to-pay $0–$100k.•Cost-effectiveness was driven mainly by length of stay and valve/device costs.

Decision model compared valve-in-valve transcatheter mitral valve replacement (ViV TMVR) vs. redo-surgical mitral valve replacement for failed bioprosthetic mitral valve.

At 1 month, ViV TMVR was less costly and more effective (dominant).

ViV TMVR was cost-effective in 83%–88% of simulations across willingness-to-pay $0–$100k.

Cost-effectiveness was driven mainly by length of stay and valve/device costs.