Abstract 12318: A Cost-effectiveness Analysis of Ventricular Assist Devices (VAD) for the Treatment of Systolic Heart Failure in Pediatric Patients

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A12318
• Main Authors: Priromprintr, Bryant, Song, Nancy, Owens, Douglas K, Salomon, Joshua, Cho, Seo-Ho, Ton, Sony, Zhao, Diana Y, Almond, Christopher S, Rosenthal, David N, Goldhaber-Fibert, Jeremy D, Shin, Andrew
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19.11.2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.12318

IntroductionCosts for treating pediatric heart failure are substantial and increasing with utilization of ventricular assist devices (VAD) as a bridge to cardiac transplant. Given the potential health benefits from improved quality of life and immediate post-transplantation outcomes, there may be lifetime cost reductions with VADs for this population. A cost-effectiveness analysis for the use of VAD in children compared to medical therapy (inotrope infusion) alone has not yet been performed.MethodsWe designed a decision analytic, computer-based simulation model of the progression of cohorts of pediatric patients with severe heart failure. The model begins with the decision to implant a VAD or continue with inotropic infusion as medical therapy through cardiac transplant, during which the two cohorts differ in cost, clinical outcomes, and quality of life. We derived model inputs from studies of pediatric heart failure identified via PubMed and Google Scholar. Outcomes included lifetime costs, life expectancy, and quality adjusted life years (QALYs) discounted at 3% annually. The analysis was conducted from a healthcare sector perspective.ResultsDespite an increase in undiscounted life expectancy of 0.57 years, VADs were not a cost-effective addition to the treatment pathway for pediatric heart failure, with an incremental cost-effectiveness ratio (ICER) of $999,172 per QALY gained. The ICER depended on the rate of transplantation, the costs of VAD implantation, and initial hospitalization. By increasing the likelihood of transplantation by 6 months after VAD implantation from 45% to 81%, the ICER improves to $407,205/QALY gained.ConclusionVADs are not yet a cost-effective treatment when compared to a willingness-to-pay (WTP) threshold of $100,000/QALY and to ICERs of other well-accepted interventions. Further analysis should account for limitations of this study and assess the cost-effectiveness of VADs in various scenarios.