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COST-EFFECTIVENESS OF CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES

Published online by Cambridge University Press:  14 June 2013

Mattias Neyt ,
Ann Van den Bruel ,
Yolba Smit ,
Nicolaas De Jonge ,
Michiel Erasmus ,
Diederik Van Dijk  and
Joan Vlayen
Mattias Neyt
Affiliation:
ME-TA, Medical Evaluation and Technology Assessment
Ann Van den Bruel
Affiliation:
ME-TA, Medical Evaluation and Technology Assessment
Yolba Smit
Affiliation:
Independent researcher
Nicolaas De Jonge
Affiliation:
Department of Cardiology, University Medical Centre Utrecht
Michiel Erasmus
Affiliation:
Department of Cardiothoracic Surgery, University Medical Centre Groningen
Diederik Van Dijk
Affiliation:
Department of Anesthesiology and Intensive Care, University Medical Centre Utrecht
Joan Vlayen
Affiliation:
ME-TA, Medical Evaluation and Technology Assessment
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Abstract

Objectives: Mechanical circulatory support through left ventricular assist devices (LVADs) improves survival and quality of life for patients with end-stage heart failure who are ineligible for cardiac transplantation. Our aim was to calculate the cost-effectiveness of continuous-flow LVADs.

Methods: A cost-utility analysis from a societal perspective was performed. A lifetime Markov model was set up in which continuous-flow LVAD was compared with optimal medical therapy (OMT). The treatment effect was modeled indirectly combining the results of the REMATCH trial comparing OMT with a pulsatile-flow LVAD and the HeartMate II Destination Therapy Trial comparing a pulsatile-flow LVAD with a continuous-flow LVAD. Cost data were based on real-world financial data of sixty-nine patients with a HeartMate II implantation from the University Medical Centre Utrecht (the Netherlands). One-way and probabilistic sensitivity analyses were performed.

Results: Comparing the continuous-flow HeartMate II with OMT, 3.23 (95 percent confidence interval [CI], 2.18–4.49) life-years were gained (LYG) or 2.83 (95 percent CI, 1.91–3.90) quality-adjusted life-years (QALYs). The cost of an LVAD implant was approximately €126,000, of which the device itself represented the largest cost, being €70,000. Total incremental costs amounted to €299,100 (95 percent CI, 190,500–521,000). This resulted in an incremental cost-effectiveness ratio of €94,100 (95 percent CI, 59,100–160,100) per LYG or €107,600 (95 percent CI, 66,700–181,100) per QALY. Sensitivity analyses showed these results were robust.

Conclusions: Although LVAD destination therapy improves survival and quality of life, it remains a relatively expensive intervention which renders the reimbursement of this therapy questionable.

Keywords

Cost-benefit analysisHeart-assist devicesLeft ventricular assist devices
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 3 , July 2013 , pp. 254 - 260
Copyright
Copyright © Cambridge University Press 2013 

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References

REFERENCES

1.Neyt, M, Smit, Y, Van den Bruel, A, Vlayen, J. Left ventricular assist device (LVAD) toegepast als bestemmingstherapie bij patiënten met eindstadium hartfalen: ME-TA, medical evaluation and technology assessment; 2011.Google Scholar
2.Rose, EA, Gelijns, AC, Moskowitz, AJ, et al.Long-term mechanical left ventricular assistance for end-stage heart failure. [Summary for patients in J Card Fail. 2002;8:59-60; PMID: 12016626]. [Summary for patients in J Card Fail. 2002;8:61-62; PMID: 12016627]. N Engl J Med. 2001;345:1435–1443.CrossRefGoogle Scholar
3.Slaughter, MS, Rogers, JG, Milano, CA, et al.Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361:2241–51.CrossRefGoogle ScholarPubMed
4.College voor zorgverzekeringen. Pakketadvies. 2007;2007.Google Scholar
5.College voor zorgverzekeringen. Richtlijnen voor farmaco-economisch onderzoek; 2006.Google Scholar
6.Dembitsky, WP, Tector, AJ, Park, S, et al.Left ventricular assist device performance with long-term circulatory support: Lessons from the REMATCH trial. Ann Thorac Surg. 2004;78:2123–2130.CrossRefGoogle ScholarPubMed
7.Coyle, LA, Ising, MS, Gallagher, C, et al.Destination therapy: One-year outcomes in patients with a body mass index greater than 30. Artif Organs. 2010;34:93–97.CrossRefGoogle ScholarPubMed
8.Moskowitz, AJ, Weinberg, AD, Oz, MC, Williams, DL. Quality of life with an implanted left ventricular assist device. Ann Thorac Surg. 1997;64:1764–1769.CrossRefGoogle ScholarPubMed
9.Hakkaart - van Roijen, L, Tan, S, Bouwmans, C. Handleiding voor kostenonderzoek: methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg (geactualiseerde versie 2010): College voor zorgverzekeringen; 2010.Google Scholar
10.Raphael, C, Briscoe, C, Davies, J, et al.Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failure. Heart. 2007;93:476–482.CrossRefGoogle ScholarPubMed
11.Spertus, J.Assessing patients’ improvement in clinical trials. BMJ. 2008;336:1258–1259.CrossRefGoogle ScholarPubMed
12.Van Brabandt, H, Camberlin, C, Neyt, M, et al.Cardiac resynchronisation therapy. A Health technology Assessment. Brussels; 2010.Google Scholar
13.Adang, E, Groenewoud, H, van Hees, F, Krabbe, P, van der Wilt, G. Invoering van kunst- en steunhart als bestemmingstherapie voor patienten met eindstadium hartfalen: Gevolgen voor ziektelast en kosten van behandeling; 2006.Google Scholar
14.Clegg, AJ, Scott, DA, Loveman, Eet al., The clinical and cost-effectiveness of left ventricular assist devices for end-stage heart failure: A systematic review and economic evaluation. HTA Technology Assessment Report: NIHR Health Technology Assessment program; 2005.Google ScholarPubMed
15.Girling, AJ, Freeman, G, Gordon, JP, Poole-Wilson, P, Scott, DA, Lilford, RJ. Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy. Int J Technol Assess Health Care. 2007;23:269–277.CrossRefGoogle ScholarPubMed
16.Messori, A, Trippoli, S, Bonacchi, M, Sani, G. Left ventricular assist device as destination therapy: Application of the payment-by-results approach for the device reimbursement. J Thorac Cardiovasc Surg. 2009;138:480–485.CrossRefGoogle ScholarPubMed
17.Rogers, JG, Bostic, RR, Tong, KB, Adamson, R, Russo, M, Slaughter, MS. Cost-effectiveness analysis of continuous-flow left ventricular assist devices as destination therapy. Circ Heart Fail. 2012;5:10–16.CrossRefGoogle ScholarPubMed
18.Kirkels, JH, De Jonge, N, Lahpor, JR. Editorial: Assist devices in the new decade: From technical developments to political decisions. Eur J Heart Fail. 2010;12:217–218.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Neyt Supplementary Material

Tables S1-S2 and Figure S1-S2

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