Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysisCentral MessagePerspective
Objective(s): Identifying the optimal solution for young adults requiring aortic valve replacement (AVR) is challenging, given the variety of options and their lifetime complication risks, impacts on quality of life, and costs. Decision analytic techniques make comparisons incorporating these measur...
| Główni autorzy: | , , , , , , , , |
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| Format: | Artykuł |
| Język: | English |
| Wydane: |
Elsevier
2024-02-01
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| Seria: | JTCVS Open |
| Hasła przedmiotowe: | |
| Dostęp online: | http://www.sciencedirect.com/science/article/pii/S2666273623003510 |
| _version_ | 1827347889721966592 |
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| author | Kunaal S. Sarnaik, BS Samuel M. Hoenig, BA Nadia H. Bakir, MD Miza Salim Hammoud, MD Rashed Mahboubi, MD Dominique Vervoort, MD, MPH, MBA Brian W. McCrindle, MD, MPH Karl F. Welke, MD, MS Tara Karamlou, MD, MSc |
| author_facet | Kunaal S. Sarnaik, BS Samuel M. Hoenig, BA Nadia H. Bakir, MD Miza Salim Hammoud, MD Rashed Mahboubi, MD Dominique Vervoort, MD, MPH, MBA Brian W. McCrindle, MD, MPH Karl F. Welke, MD, MS Tara Karamlou, MD, MSc |
| author_sort | Kunaal S. Sarnaik, BS |
| collection | DOAJ |
| description | Objective(s): Identifying the optimal solution for young adults requiring aortic valve replacement (AVR) is challenging, given the variety of options and their lifetime complication risks, impacts on quality of life, and costs. Decision analytic techniques make comparisons incorporating these measures. We evaluated lifetime valve-related outcomes of mechanical aortic valve replacement (mAVR) versus the Ross procedure (Ross) using decision tree microsimulations modeling. Methods: Transition probabilities, utilities, and costs derived from published reports were entered into a Markov model decision tree to explore progression between health states for hypothetical 18-year-old patients. In total, 20,000 Monte Carlo microsimulations were performed to model mortality, quality-adjusted-life-years (QALYs), and health care costs. The incremental cost-effectiveness ratio (ICER) was calculated. Sensitivity analyses was performed to identify transition probabilities at which the preferred strategy switched from baseline. Results: From modeling, average 20-year mortality was 16.3% and 23.2% for Ross and mAVR, respectively. Average 20-year freedom from stroke and major bleeding was 98.6% and 94.6% for Ross, and 90.0% and 82.2% for mAVR, respectively. Average individual lifetime (60 postoperative years) utility (28.3 vs 23.5 QALYs) and cost ($54,233 vs $507,240) favored Ross over mAVR. The average ICER demonstrated that each QALY would cost $95,345 more for mAVR. Sensitivity analysis revealed late annual probabilities of autograft/left ventricular outflow tract disease and homograft/right ventricular outflow tract disease after Ross, and late death after mAVR, to be important ICER determinants. Conclusions: Our modeling suggests that Ross is preferred to mAVR, with superior freedom from valve-related morbidity and mortality, and improved cost-utility for young adults requiring aortic valve surgery. |
| first_indexed | 2024-03-07T23:59:32Z |
| format | Article |
| id | doaj.art-218641343c424a0bb84d692d7f5e4973 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-07T23:59:32Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-218641343c424a0bb84d692d7f5e49732024-02-18T04:43:43ZengElsevierJTCVS Open2666-27362024-02-0117185214Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysisCentral MessagePerspectiveKunaal S. Sarnaik, BS0Samuel M. Hoenig, BA1Nadia H. Bakir, MD2Miza Salim Hammoud, MD3Rashed Mahboubi, MD4Dominique Vervoort, MD, MPH, MBA5Brian W. McCrindle, MD, MPH6Karl F. Welke, MD, MS7Tara Karamlou, MD, MSc8Case Western Reserve University School of Medicine, Cleveland, OhioCase Western Reserve University School of Medicine, Cleveland, OhioDepartment of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, OhioDepartment of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, OhioDepartment of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, OhioDivision of Cardiac Surgery, University of Toronto, Toronto, Ontario, CanadaLabatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, CanadaDivision of Pediatric Cardiothoracic Surgery, Atrium Health Levine Children’s Hospital, Charlotte, NCDepartment of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio; Address for reprints: Tara Karamlou, MD, MSc, Division of Pediatric Cardiac Surgery, Cleveland Clinic Children’s, and the Heart, Vascular, and Thoracic Institute, M41-022A, 9500 Euclid Ave, Cleveland, OH 44195.Objective(s): Identifying the optimal solution for young adults requiring aortic valve replacement (AVR) is challenging, given the variety of options and their lifetime complication risks, impacts on quality of life, and costs. Decision analytic techniques make comparisons incorporating these measures. We evaluated lifetime valve-related outcomes of mechanical aortic valve replacement (mAVR) versus the Ross procedure (Ross) using decision tree microsimulations modeling. Methods: Transition probabilities, utilities, and costs derived from published reports were entered into a Markov model decision tree to explore progression between health states for hypothetical 18-year-old patients. In total, 20,000 Monte Carlo microsimulations were performed to model mortality, quality-adjusted-life-years (QALYs), and health care costs. The incremental cost-effectiveness ratio (ICER) was calculated. Sensitivity analyses was performed to identify transition probabilities at which the preferred strategy switched from baseline. Results: From modeling, average 20-year mortality was 16.3% and 23.2% for Ross and mAVR, respectively. Average 20-year freedom from stroke and major bleeding was 98.6% and 94.6% for Ross, and 90.0% and 82.2% for mAVR, respectively. Average individual lifetime (60 postoperative years) utility (28.3 vs 23.5 QALYs) and cost ($54,233 vs $507,240) favored Ross over mAVR. The average ICER demonstrated that each QALY would cost $95,345 more for mAVR. Sensitivity analysis revealed late annual probabilities of autograft/left ventricular outflow tract disease and homograft/right ventricular outflow tract disease after Ross, and late death after mAVR, to be important ICER determinants. Conclusions: Our modeling suggests that Ross is preferred to mAVR, with superior freedom from valve-related morbidity and mortality, and improved cost-utility for young adults requiring aortic valve surgery.http://www.sciencedirect.com/science/article/pii/S2666273623003510Ross procedureaortic valve replacementdecision analysis |
| spellingShingle | Kunaal S. Sarnaik, BS Samuel M. Hoenig, BA Nadia H. Bakir, MD Miza Salim Hammoud, MD Rashed Mahboubi, MD Dominique Vervoort, MD, MPH, MBA Brian W. McCrindle, MD, MPH Karl F. Welke, MD, MS Tara Karamlou, MD, MSc Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysisCentral MessagePerspective JTCVS Open Ross procedure aortic valve replacement decision analysis |
| title | Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysisCentral MessagePerspective |
| title_full | Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysisCentral MessagePerspective |
| title_fullStr | Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysisCentral MessagePerspective |
| title_full_unstemmed | Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysisCentral MessagePerspective |
| title_short | Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysisCentral MessagePerspective |
| title_sort | ross procedure or mechanical aortic valve which is the best lifetime option for an 18 year old a decision analysiscentral messageperspective |
| topic | Ross procedure aortic valve replacement decision analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623003510 |
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