Cost-Effectiveness Analysis of Continuous-Flow Left Ventricular Assist Devices as Destination Therapy

Rogers, Joseph G.; Bostic, Robin; Tong, Karen A.; Adamson, R.M.; Russo, Mark J.; Slaughter, Mark S.

doi:10.1161/circheartfailure.111.962951

Cited by 136 publications

(104 citation statements)

References 22 publications

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“…Broader cost and resource-utilization issues also affect clinical care delivery to these patients. 24 Furthermore, understanding hospital patterns and trends toward readmission might help us answer an important underlying question: does implanting an LVAD into a patient who already has a complex, multimorbid condition make that patient less likely to need repeated hospitalizations? Clearly, LVAD therapy improves survival rates and the quality of life; the question is whether or not-by improving cardiac output-LVAD therapy can ultimately simplify the care of these patients.…”

Section: Discussionmentioning

confidence: 99%

Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study

Hernandez¹,

Singh²,

Hoang³

et al. 2015

Texas Heart Institute Journal

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A Large Single-Center StudyLeft ventricular assist device (LVAD) C irculatory support with left ventricular assist devices (LVADs) has emerged as a powerful therapy that can improve outcomes in patients who have advanced heart failure (HF) refractory to medical therapy.1-3 The scarcity of donor organs severely limits transplantation as an option for patients with advanced HF; moreover, transplant patients need lifelong immunosuppression, the medications for which can have their own serious side effects. The newest generation of LVADs comprises continuous-flow (CF) pumps, which use axial or centrifugal technology, deliver flows of up to 10 L/min, 2,4 and are smaller and more durable than previous models. Currently, these LVADs are implanted either as a bridge to transplantation (BTT) or as destination therapy (DT), which offers a permanent alternative to transplantation.Recently, patients with end-stage HF were given new options when the U.S. Food and Drug Administration (FDA) approved 2 continuous-flow LVADs: the HeartMate ® II (Thoratec Corporation; Pleasanton, Calif ) and the HeartWare ® Ventricular Assist System (HeartWare Inc.; Framingham, Mass). The HeartMate II was approved for BTT in 2008 and for DT in 2010, and the HeartWare was approved for BTT in 2012. These milestones initiated modern LVAD therapy, enabling this treatment to become available to a larger population of patients. [5][6][7][8][9] Consequently, LVAD use has dramatically increased throughout the world, particularly for DT, and growing numbers of medical centers are offering device therapy. [9][10][11] This trend has been bolstered by reports that LVAD use, in HF patients 70 years of age or older, is associated with

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Section: Discussionmentioning

confidence: 99%

Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study

Hernandez¹,

Singh²,

Hoang³

et al. 2015

Texas Heart Institute Journal

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“…It was close to the Netherland's ICER (€107 600–€112 000/QALY) 11, 27. However, French ICER was significantly lower than published estimates coming from the USA 14, 15. Obviously, the USA has a less parsimonious approach than France, with healthcare expenditure per capita in 2014 almost twice the French level.…”

Section: Discussionmentioning

confidence: 74%

“…Economic evaluations of first‐generation and second‐generation LVADs showed that the ratio of incremental costs vs. incremental benefits is still relatively high, ranging from £53 527 ($84 963)/quality‐adjusted life year (QALY) in the UK to $201 600/QALY in the USA 8, 11, 14, 15, 16…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of left ventricular assist devices for patients with end‐stage heart failure: analysis of the French hospital discharge database

Tadmouri¹,

Blomkvist²,

Landais³

et al. 2017

ESC Heart Failure

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AimsAlthough left ventricular assist devices (LVADs) are currently approved for coverage and reimbursement in France, no French cost‐effectiveness (CE) data are available to support this decision. This study aimed at estimating the CE of LVAD compared with medical management in the French health system.Methods and resultsIndividual patient data from the ‘French hospital discharge database’ (Medicalization of information systems program) were analysed using Kaplan–Meier method. Outcomes were time to death, time to heart transplantation (HTx), and time to death after HTx. A micro‐costing method was used to calculate the monthly costs extracted from the Program for the Medicalization of Information Systems. A multistate Markov monthly cycle model was developed to assess CE. The analysis over a lifetime horizon was performed from the perspective of the French healthcare payer; discount rates were 4%. Probabilistic and deterministic sensitivity analyses were performed. Outcomes were quality‐adjusted life years (QALYs) and incremental CE ratio (ICER). Mean QALY for an LVAD patient was 1.5 at a lifetime cost of €190 739, delivering a probabilistic ICER of €125 580/QALY [95% confidence interval: 105 587 to 150 314]. The sensitivity analysis showed that the ICER was mainly sensitive to two factors: (i) the high acquisition cost of the device and (ii) the device performance in terms of patient survival.ConclusionsOur economic evaluation showed that the use of LVAD in patients with end‐stage heart failure yields greater benefit in terms of survival than medical management at an extra lifetime cost exceeding the €100 000/QALY. Technological advances and device costs reduction shall hence lead to an improvement in overall CE.

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“…[3][4][5][6] In the United States, a general rule is that ICERs under $50,000 per QALY are considered cost-effective, while $50,000-$100,000 per QALY (perhaps as high as $200,000 for a continuous flow left ventricular assist device as destination therapy in patients with heart failure) is a gray area. 7 How do you evaluate the quality of cost-effectiveness studies? Good research practices for cost-effectiveness studies are available from an internationally recognized joint task force (see reference 8 for the Web link).…”

Section: How Is the Value Of A New Treatment Technology Or Practicementioning

confidence: 99%

Reading a cost-effectiveness or decision analysis study

2013

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SummaryCost-effectiveness studies and decision analyses of neurologic practices, treatments, and technologies are increasing in the literature and have an emerging role within both medicine and neurology. Knowledge about these research approaches, how to interpret the results of such studies, as well as an understanding of their limitations will be of growing importance for the practicing neurologist. We discuss 5 aspects of these analyses to increase awareness about the uses and limitations of cost-effectiveness articles in everyday practice. C ost-effectiveness research encompasses methods that determine the cost and health-related outcomes of 2 or more competing technologies, interventions, or medications. Decision analysis broadly encompasses similar principles of comparing future, long-term, outcomes from 2 or more alternative regimens. The overarching purpose of cost-effectiveness analyses is to identify strategies that maximize health gains with the resources at hand-or, alternatively, to improve value for money.The past few years have seen increases in the number of cost-effectiveness publications, primarily in the area of stroke but in other neurologic disciplines as well (figure 1). These research approaches have the potential to assist decision-makers in efficiently allocating resources. Here, we provide an overview of the key considerations in cost-effectiveness research to help the practicing clinician better understand the implications and limitations of this field.Editorial,

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Cost-Effectiveness Analysis of Continuous-Flow Left Ventricular Assist Devices as Destination Therapy

Cited by 136 publications

References 22 publications

Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study

Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study

Cost‐effectiveness of left ventricular assist devices for patients with end‐stage heart failure: analysis of the French hospital discharge database

Reading a cost-effectiveness or decision analysis study

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