COST-EFFECTIVENESS OF CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES

• Published in: International journal of technology assessment in health care Vol. 29; no. 3; pp. 254 - 260
• Main Authors: Neyt, Mattias, Van den Bruel, Ann, Smit, Yolba, De Jonge, Nicolaas, Erasmus, Michiel, Van Dijk, Diederik, Vlayen, Joan
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.07.2013
• Subjects: ASSESSMENTS; Confidence Intervals; Cost analysis; Cost-Benefit Analysis; Devices; Failure; Heart failure; Heart Failure - surgery; Heart transplants; Heart-Assist Devices - economics; Humans; Markov Chains; Mortality; Netherlands; Patients; Quality of life; Quality-Adjusted Life Years; Sensitivity analysis; Survival; Therapy; Transplants & implants; Treatment Outcome; Ventricular assist devices; Ventricular Dysfunction, Left - surgery; Netherlands; Cost-benefit analysis; Left ventricular assist devices; Heart-assist devices
• ISSN: 0266-4623; 1471-6348
• DOI: 10.1017/S0266462313000238

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.