Assessment of the Cost-effectiveness of Tricuspid Valve Repair

An economic evaluation of Tricuspid Valve Repair versus medical management in patients who could not have tricuspid valve surgery was conducted.  Published studies were used where possible, supplemented by expert (cardiologist) opinion. This was an indirect evaluation, meaning that all the data did not come from one randomised trial of Tricuspid repair versus medical therapy.  The published data were available up to 2 years follow-up and the time horizon was 5 years, hence there was a minimum extrapolation of the data, which is good.

Where possible, English tariff prices were used, but some prices were extracted from the literature and inflated to the same year as tariff prices.

Events considered after the procedure were mortality, myocardial infarction, stroke, bleeding and heart failure hospitalisation.

Cost-effectiveness was reported as incremental cost per QALY gained.

Deterministic results (using the reported results from the study and reported costs) and probabilistic results (where the majority of inputs were as probability distributions reflecting the uncertainty in the data) were reported.  1,000 cost-effectiveness results were estimated in the probabilistic analysis.  Using the probabilistic analysis, a Cost-effectiveness Plane and a Cost-effectiveness Acceptability Curve were constructed, the latter so that the likelihood of cost-effectiveness at various thresholds could be reported.  A Cost-effectiveness Plane shows the number of scenarios that fall into categories of less cost less effective, less cost more effective, more cost less effective and more cost more effective.  Also, for the deterministic analysis, sensitivity to changes in the results was assessed and reported as a Tornado Chart. 

A report was prepared showing how the analysis was done and what the results were.  A list of references was included so that it could be seen which sources were used and when internet sources were accessed.