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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

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Supplementary material: PDF

Neyt Supplementary Material

Tables S1-S2 and Figure S1-S2

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