“对于COAPT患者来说，TMVr的成本效益与其他常用的治疗心力衰竭的技术相当，包括植入式心脏除颤器，而且比使用持续流动左心室辅助设备进行目的地治疗更具成本效益，”马萨诸塞州伯灵顿Lahey医院和医疗中心介入心脏病研究主任Suzanne J.Baron医学博士说。“结合COAPT试验的临床结果有所改善，这些发现表明，基于临床和经济考虑，TMVr是该患者群体的合理治疗策略。”

 

 

　　Background

　　The COAPT trial demonstrated that edge-to-edge transcatheter mitral valve repair (TMVr) using the MitraClip resulted in reduced mortality and heart-failure hospitalizations and improved quality of life when compared with maximally-tolerated guideline-directed medical therapy (GDMT) in heart-failure patients with 3-4+ secondary mitral regurgitation (SMR). Whether TMVr is cost-effective compared with GDMT in this population is unknown.

 

　　COAPT研究表明，与GDMT相比，使用二尖瓣钳夹术（MitraClip）进行二尖瓣经导管修复（TMVr）可降低有症状性心力衰竭和3 - 4 二尖瓣返流（SMR）患者的死亡率和心力衰竭住院率，并改善生活质量。在这种人群中，TMVr与GDMT相比是否具有成本效益尚不清楚。

 

　　Methods

　　We used data from the COAPT trial to perform a formal， patient-level economic analysis of TMVr + GDMT vs. GDMT alone for patients with heart failure and 3-4+ SMR from the perspective of the US health care 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 based on medical resource use collected during the COAPT trial. Health utilities were estimated for all patients at baseline， 1， 6， 12 and 24 months using the SF-6D.

 

　　我们使用COAPT试验数据，从美国医疗体系的角度，对心力衰竭合并3-4 SMR患者分别进行TMVr GDMT和单独GDMT的正式、患者层面的经济分析。结合使用基于资源的会计和医院账单数据（如有），评估TMVr住院指数的成本。根据COAPT试验期间收集的医疗资源使用情况估算后续医疗费用。使用SF-6D对所有患者在基线、1、6、12和24个月的健康效用进行评估。

 

　　Results

　　Initial costs for the TMVr procedure and index hospitalization were