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

Tadmouri, Abir; Blomkvist, Josefin; Landais, C.; Seymour, Jerome; Azmoun, Alexandre

doi:10.1002/ehf2.12194

Cited by 22 publications

(13 citation statements)

References 29 publications

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“…the Canadian analyses utilize a bottom-up unit cost allocation according to clinical data and expert opinion, vs the analysis presented here which is based on real world cost data by admission and reflects the true costs to the payer for TAVI and, critically, for sAVR. Moreover, to our knowledge TAVI is highly unusual in being both clinically beneficial and cost saving in comparison with other technologies where analyses are based on empirical French cost data derived from current practice [18][19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of the SAPIEN 3 TAVI valve compared with surgery in intermediate-risk patients

Goodall

Lamotte²,

Ramos³

et al. 2019

Journal of Medical Economics

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Objective: Transcatheter aortic valve implantation (TAVI) has become the therapy of choice for treating severe aortic stenosis in patients at high-risk for surgery or where it is considered too risky to attempt. This uptake varies across geographies however, and its cost or value has frequently been cited as the reason for this. We sought to evaluate the potential cost and clinical impact of TAVI in intermediate risk patients from a French collective perspective. Materials and methods: The analysis was performed using a novel Markov model with data derived from the PARTNER II randomized controlled trial for survival, clinical event rates, and quality-of-life. The simulated time horizon was 15 years, costs were from French sources and presented in 2016 Euros. Discounting of all outcomes was at 4% annually and the effect of uncertainty in model parameters was explored by deterministic and probabilistic sensitivity analysis (PSA). Results: In comparison to surgery, TAVI resulted in improved clinical outcomes (life expectancy and quality-adjusted life expectancy) and lower costs over a lifetime time horizon. The base case results showed increases of 0.42 years and 0.41 QALYs with lifetime cost savings of e439 for TAVI compared to surgery. PSA results showed a >50% likelihood of cost-effectiveness at e0 willingness-to-pay and a 100% likelihood at $e15,000. Limitations: Clinically, survival projections are based on limited follow-up data and introduce uncertainty into the outcomes from the model. Economically, procedure costs are derived from a heterogeneous mix of patient risk groups, although this is much more likely to bias against TAVI and underestimate overall cost savings. Conclusions: In our analyses of intermediate risk patients, TAVI is associated with superior clinical outcomes compared to surgery and is cost saving. It could be expected that cost savings are conservative and likely to increase over time.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of the SAPIEN 3 TAVI valve compared with surgery in intermediate-risk patients

Goodall

Lamotte²,

Ramos³

et al. 2019

Journal of Medical Economics

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“…Previously, we showed that up to 25% of readmissions are due to infections, suggesting that implementing measures that reduce infections could greatly decrease readmission rates and associated costs. Although several studies have examined the cost‐effectiveness of LVAD therapy versus medical management in patients with advanced heart failure, additional studies are necessary to differentiate the effects of different device types, with consideration of the associated readmission costs of adverse events such as infection. By using devices associated with lower infection rates, we may be able to minimize morbidity and the cost of multiple readmissions on the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

Severe LVAD-related infections requiring surgical treatment: Incidence, predictors, effect on survival, and impact of device selection

et al. 2019

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Background Left ventricular assist devices (LVADs) are being used more frequently for treating refractory, advanced heart failure. However, infection remains a frequent complication. In this study, we analyzed the incidence of severe infections in LVAD recipients to determine its impact on survival. Methods From May 2009 through March 2016, 437 patients with advanced heart failure underwent implantation of a continuous‐flow LVAD (n = 314, HeartMate II LVAD [Abbott Laboratories, Abbott Park, IL]; n = 123 HeartWare HVAD [Medtronic, Minneapolis, MN]). We analyzed the rate of severe device infection requiring surgical intervention or involving sepsis and the impact of severe infection on outcomes in patients on long‐term LVAD support. Results Infection occurred in 244 patients (HeartMate II, n = 186; HVAD, n = 58); severe infections developed in 160 patients (HeartMate II, n = 119; HVAD, n = 41). HeartMate II recipients had 344 severe infection events (0.63 events per patient‐year [EPPY]), whereas HeartWare recipients had 89 severe infection events (0.42 EPPY; P = 0.047). HeartMate II recipients had a higher incidence of pump infections (P < 0.001). Severe infections did not significantly affect survival (P = 0.42). Conclusions Although HeartMate II patients had a significantly higher incidence of pump infections requiring surgical treatment, survival was not adversely affected. The difference in postoperative infection rates may be an important factor in device type selection.

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“…Analyses of advanced heart failure populations targeted as candidates for heart transplantation, and thereby use of LVASs as a bridge, have found affirmation in several countries that have deemed such a use to fall within acceptable cost-effectiveness ratios; however, use of this technology in transplant-ineligible patients (those considered as DT) has not received widespread endorsement. 20,21 Using a Markov model in the context of a contemporary continuous-flow LVAS use, Rogers and colleagues 4 demonstrated that, in comparison with medically managed patients, these devices had an incremental costeffectiveness ratio of $198 184 per quality-adjusted life-year gained. It is important to note that they determined that the results were most sensitive to the initial cost of device implantation and subsequent cost per rehospitalization.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Resource Use and Cost Implications in the MOMENTUM 3 Long-Term Outcome Study

et al. 2018

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BACKGROUND:The MOMENTUM 3 trial compares the centrifugal HeartMate 3 (HM3) with the axial HeartMate II (HMII) continuous-flow left ventricular assist system in patients with advanced heart failure, irrespective of the intended goal of therapy. The trial's 2-year clinical outcome (n=366) demonstrated superiority of the HM3 for the primary end point (survival free of a disabling stroke or reoperation to replace or remove a malfunctioning pump). This analysis evaluates health resource use and cost implications of the observed differences between the 2 devices while patients were enrolled in the trial. METHODS:We analyzed all hospitalizations and their associated costs occurring after discharge from the implant hospitalization until censoring (study withdrawal, heart transplantation, and pump exchange with a nonstudy device or death). Each adjudicated episode of hospital-based care was used to calculate costs (device-attributable and non-device-attributable event costs), estimated by using trial data and payer administrative claims databases. Cost savings stratified by subgroups (study outcome [transplant, death, or ongoing on device], intended goal of therapy, type of insurance, or sex) were also assessed. RESULTS:In 366 randomly assigned patients, 361 comprised the as-treated group (189 in the HM3 group and 172 in the HMII group), of whom 337 (177 in the HM3 group and 160 in the HMII group) were successfully discharged following implantation. The HM3 arm experienced fewer total hospitalizations per patient-year (HM3: 2.1±0.2 versus HMII: 2.7±0.2; P=0.015) and 8.3 fewer hospital days per patient-year on average (HM3: 17.1 days versus HMII: 25.5 days; P=0.003). These differences were driven by patients hospitalized for suspected pump thrombosis (HM3: 0.6% versus HMII: 12.5%; P<0.001) and stroke (HM3: 2.8% versus HMII: 11.3%; P=0.002). Controlled for time spent in the study (average cumulative cost per patient-year), postdischarge HM3 arm costs were 51% lower than with the HMII (HM3: $37 685±4251 versus HMII: $76 599±11 889, P<0.001) and similar in either bridge to transplant or destination therapy intent. CONCLUSIONS:In this 2-year outcome economic analysis of the MOMENTUM 3 trial, the HM3 demonstrated a reduction in rehospitalizations, hospital days spent during rehospitalizations, and a significant cost savings following discharge in comparison with the HMII left ventricular assist system, irrespective of the intended goal of therapy. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02224755.

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

Cited by 22 publications

References 29 publications

Cost-effectiveness analysis of the SAPIEN 3 TAVI valve compared with surgery in intermediate-risk patients

Cost-effectiveness analysis of the SAPIEN 3 TAVI valve compared with surgery in intermediate-risk patients

Severe LVAD-related infections requiring surgical treatment: Incidence, predictors, effect on survival, and impact of device selection

Healthcare Resource Use and Cost Implications in the MOMENTUM 3 Long-Term Outcome Study

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