Cost-Effectiveness of Referring Patients to Centers of Excellence for Mitral Valve Surgery
dc.contributor.author | Wang, Guihua | |
dc.contributor.author | Li, Jun | |
dc.contributor.author | Hopp, Wallace J. | |
dc.contributor.author | Fazzalari, Franco L. | |
dc.contributor.author | Bolling, Steven | |
dc.date.accessioned | 2015-06-18T14:05:21Z | |
dc.date.available | 2015-06-18T14:05:21Z | |
dc.date.issued | 2015-05 | |
dc.identifier | 1281 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/111881 | |
dc.description.abstract | BACKGROUND The 2014 American Heart Association/American College of Cardiology Valvular Heart Disease Guidelines state that mitral valve diseases should be repaired at a Center of Excellence (CoE). We evaluate the cost-effectiveness of such referrals. METHODS We estimate patients’ life expectancy based on projected survival of patients after mitral valve surgery and develop a cost model to calculate short- and long-term benefits and costs to both patients and payers. Benefits include increased life expectancy and avoidance of medical complications for patients. Short-term costs include all upfront payments by patients and payers at the time of discharge. Long-term costs include all payments associated with the condition that prompted the surgical procedure incurred during the remainder of a patient’s life. We assess cost-effectiveness of treating patients with various ages and major comorbidities at CoEs vs non-CoEs. RESULTS Full implementation of the guidelines would result in an increase in the percentage of patients obtaining mitral valve repair instead of valve replacement from 58% to 72%. Depending on the patient’s age and comorbidities, it would also result in a 6.64% to 12.47% reduction in mortality, 7.85% to 9.97% reduction in reoperation, 9.97% to 17.16% reduction in stroke, and an average gain of 3.77 to 9.88 months of life expectancy. Finally, greater reliance on CoEs results in financial savings to payers, due to avoidance of the costs of future complications. CONCLUSION Patients benefit from mitral valve surgery at a CoE regardless of their age or comorbidities. Payers may incur additional short-term costs when patients are referred to a CoE, but these are fully offset by long-term savings at the current repair rate gap of 24% between CoEs and non-CoEs in New York State. Redesigning co-pay structures and/or refining the set of patients who are referred to CoEs could further align the incentives of patients and payers on a case-by-case basis and achieve an even more desirable social outcome. | en_US |
dc.subject | Cardiac Surgery | en_US |
dc.subject | Healthcare Outcomes | en_US |
dc.subject | Cost Effectiveness | en_US |
dc.subject.classification | Operations and Management Science | en_US |
dc.title | Cost-Effectiveness of Referring Patients to Centers of Excellence for Mitral Valve Surgery | en_US |
dc.type | Working Paper | en_US |
dc.subject.hlbsecondlevel | Management | en_US |
dc.subject.hlbtoplevel | Business | |
dc.contributor.affiliationum | Ross School of Business | en_US |
dc.contributor.affiliationum | Ross School of Business | en_US |
dc.contributor.affiliationum | Ross School of Business | en_US |
dc.contributor.affiliationum | University of Michigan Hospitals | en_US |
dc.contributor.affiliationum | University of Michigan Hospitals | en_US |
dc.contributor.affiliationumcampus | Ann Arbor | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/111881/1/1281_Wang.pdf | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/111881/4/1281_Wang_May2015.pdf | |
dc.description.filedescription | Description of 1281_Wang_May2015.pdf : May 2015 revision | |
dc.owningcollname | Business, Stephen M. Ross School of - Working Papers Series |
Files in this item
Remediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.