Cost-Effectiveness of Referring Patients to Centers of Excellence for Mitral Valve Surgery

摘要: BACKGROUNDThe 2014 American Heart Association/American College of Cardiology Valvular Disease Guidelines state that mitral valve diseases should be repaired at a Center Excellence (CoE). We evaluate the cost-effectiveness such referrals. METHODSWe estimate patients’ life expectancy based on projected survival patients after surgery and develop cost model to calculate short- long-term benefits costs both payers. Benefits include increased avoidance medical complications for patients. Short-term all upfront payments by payers time discharge. Long-term associated with condition prompted surgical procedure incurred during remainder patient’s life. assess treating various ages major comorbidities CoEs vs non-CoEs. RESULTSFull implementation guidelines would result in an increase percentage obtaining repair instead replacement from 58% 72%. Depending age comorbidities, it also 6.64% 12.47% reduction mortality, 7.85% 9.97% reoperation, 17.16% stroke, average gain 3.77 9.88 months expectancy. Finally, greater reliance results financial savings payers, due future complications.CONCLUSIONPatients benefit CoE regardless their or comorbidities. Payers may incur additional short-term when are referred CoE, but these fully offset current rate gap 24% between non-CoEs New York State. Redesigning co-pay structures and/or refining set who could further align incentives case-by-case basis achieve even more desirable social outcome.