Evidence map›Paper›PMID 32693045›Full record

ArticleThe Annals of thoracic surgery2021

Economic Analysis and Long-term Follow-up of Distant Referral for Degenerative Mitral Valve Repair.

Alexander A Brescia, Michael J Paulsen, Tessa M F Watt, Liza M Rosenbloom, Alexander M Wisniewski, Jun Li, Guihua Wang, Donald S Likosky, Wallace J Hopp, Steven F Bolling and 1 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Annals of thoracic surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.3field-weighted citation impact, top 39% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 2 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Alexander A BresciaDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan. Electronic address: abrescia@med.umich.edu.
Michael J PaulsenDepartment of Cardiothoracic Surgery, Stanford University, Palo Alto, California.
Tessa M F WattDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Liza M RosenbloomDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Alexander M WisniewskiDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Jun LiRoss School of Business, University of Michigan, Ann Arbor, Michigan.
Guihua WangNaveen Jindal School of Management, University of Texas-Dallas, Dallas, Texas.
Donald S LikoskyDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Wallace J HoppRoss School of Business, University of Michigan, Ann Arbor, Michigan.
Steven F BollingDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Michigan Mitral Research Group (MMRG)
University of Michigan–Ann Arbor · USStanford University · US

Funding

Vascular Surgery: Research Training in Vascular BiologyT32HL076123 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI HENKE, PETER K, WAKEFIELD, THOMAS WILLIAM · 2004 to 2019
$1.9M
NHLBI NIH HHS T32 HL076123
6 · The paper itself

Abstract

backgroundDespite the superiority of mitral valve repair (MVr) over replacement for degenerative disease, repair rates vary widely across centers. Traveling to a mitral reference center (MRC) is 1 way to increase the odds of MVr. This study assessed the economic value (quality/cost) and long-term outcomes of distant referral to an MRC.

methodsAmong 746 mitral surgery patients between January 2011 and June 2013, low-risk patients with an ejection fraction greater than 40% undergoing isolated degenerative MVr were identified and included 26 out-of-state (DISTANT) and 104 in-state patients (LOCAL). Short- and long-term outcomes and institutional financial data (including travel expenses) were used to compare groups. National average and MRC-specific MVr rates, clinical outcomes, and marginal value of quality-adjusted life-years collected from The Society of Thoracic Surgeons database and Medicare estimates were used to perform a nationally representative cost-benefit analysis for distant referral.

resultsAge, ejection fraction, operative time, blood transfusions, and annuloplasty ring size did not differ between groups. Median charges were $76,022 for LOCAL and $74,171 for DISTANT (P = .35), whereas median payments (including travel expenses) were $57,795 for LOCAL and $58,477 for DISTANT (P = .70). Short- and long-term outcomes were similar between groups and median follow-up was 7.1 years. Estimated 5-year survival was 97% (96% for LOCAL and 100% for DISTANT; P = .24). Cost-benefit analysis showed a net benefit through distant referral to an MRC ranging from $436 to $6078 to the payer and $22,163 to $30,067 to the patient, combining for an estimated $22,599 to $32,528 societal benefit.

conclusionsThese data suggest that distant referral to an MRC is achievable and reasonable.

Indexed as

Chronic DiseaseCosts and Cost AnalysisFemaleFollow-Up StudiesHeart Valve Prosthesis ImplantationHumansMaleMedicareMiddle AgedMitral ValveMitral Valve InsufficiencyReferral and ConsultationRetrospective StudiesTime FactorsTreatment OutcomeUnited States

Identifiers

PMID32693045
PMCPMC7855358
OpenAlexW3042249291

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.