Key result
Valvular heart disease surgery proves cost-effective in all LMIC and most HIC studies.
Why the study?
Global disparities in valvular surgery services exist, and economic evaluations can guide national investment decisions.
What is the cost-effectiveness of valvular surgery strategies across high- and low- to middle-income countries?
Systematic Review (n=20)
What is the cost-effectiveness of valvular surgery strategies across high- and low- to middle-income countries?
Economic evaluations for valvular surgery are predominantly conducted in high-income countries for adult conditions, highlighting a need for more analyses in low- and middle-income countries.
Supports valvular surgery implementation across income settings; extends economic evidence while underscoring need for expanded HIC and pediatric analyses.
BACKGROUND: Global disparities in valvular surgery services exist. Cost-effectiveness analysis (CEA) and cost-utility analysis can be used to guide national investment decisions. This scoping review aims to synthesize economic evaluations for valvular surgery by income settings and provide recommendations. METHODS: A systematic literature review identified primary CEAs or CUAs in English comparing surgical management strategies for valvular heart disease. MEDLINE, Embase, CINAHL, Web of Science, and Business Source Complete were searched using keywords "valvular surgery," "valve disease," "cost-effectiveness," and "cost-benefit analysis". Articles comparing outcomes or costs only were excluded. Search results were uploaded and screened on COVIDENCE. Variables from eligible articles were charted in a spreadsheet. RESULTS: Twenty articles were eligible, six from low- and middle-income countries (LMICs) and 14 from high-income countries (HICs). In HICs, the top conditions were degenerative aortic valve disease (7/14) and mitral valve disease (4/14) compared to congenital (2/6) and rheumatic heart diseases (2/6) in LMICs. HICs evaluated new technologies and techniques, whereas LMICs compared different valve types or surgery versus no intervention. Most articles used published studies (12/20) or databases (7/20) to conduct their CEA and quality-adjusted life years was the most common effectiveness measure (12/20). Comparator interventions were cost-effective in all LMIC articles and in 8/14 for HICs. CONCLUSION: Economic evaluations are mostly conducted in HICs and for adult conditions. More analyses in LMICs are needed. This can be facilitated by maintaining databases, documenting costs, and implementing quality of life assessments.
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Mlambo et al. (2024) conducted a systematic review in Valvular heart disease (n=20). Surgical management strategies vs. Alternative surgical strategies or no intervention was evaluated on Cost-effectiveness. A scoping review of 20 economic evaluations found that surgical interventions for valvular heart disease were cost-effective in all 6 LMIC studies and 8 of 14 HIC studies.
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