Patient Risk-Benefit Preferences for Transcatheter versus Surgical Mitral Valve Repair

ABSTRACT BACKGROUND Transcatheter repair of mitral regurgitation (MR) is less invasive than surgery, but has greater five-year mortality and re-intervention risks, as well as more limited functioning. The study objective was to quantify patient preferences for risk-benefit tradeoffs associated with transcatheter and surgical options for MR. METHODS A discrete-choice experiment survey was administered to patients with MR recruited through a patient advocacy organization. Attributes (and levels) included: procedure type (transcatheter versus surgical); risk of 30-day mortality (2%, 5%, and 10%); risk of five-year mortality (20%, 30%, and 45%) and physical functioning for five years (corresponding to improvements from New York Heart Association [NYHA] class III to I or class III to II); number of hospitalizations (1, 4, and 8) in the next five years; and risk of additional surgery in the next five years (10%, 20%, and 30% or 40%). A mixed-logit regression model was fit to estimate preference weights. RESULTS 201 individuals completed the survey: 63% were female; mean age was 74 years. On average, respondents preferred transcatheter repair over surgery. To undergo a less invasive procedure (i.e., transcatheter repair), respondents would accept up to a 13.3% (95% confidence interval [CI]: 8.7% to 18.5%) increase in re-intervention risk above a baseline of 10%, 4.6 (95% CI: 3.1 to 6.2) more hospitalizations above a baseline of one, a 9.3% (95% CI: 5.2% to 14.3%) increase in mortality risk above a baseline of 20%, or more limited physical functioning representing nearly one NYHA class (0.8, 95% CI: 0.5 to 1.3) over five years. CONCLUSIONS Patients in general preferred a transcatheter procedure over surgery. When holding constant all other factors, a functional improvement from NYHA class III to class I maintained over five years would be needed, on average, for patients to prefer surgery over a transcatheter procedure.