Cost-effectiveness of left ventricular assist devices (LVADs) for patients with advanced heart failure: Analysis of the British NHS bridge to transplant (BTT) program

Clarke, Aileen; Pulikottil-Jacob, Ruth; Connock, Martin; Suri, Gaurav; Kandala, Ngianga Bakwin; Maheswaran, Hendramoorthy; Banner, Nicholas R.; Sutcliffe, Paul

doi:10.1016/j.ijcard.2013.12.015

Cited by 52 publications

(67 citation statements)

References 20 publications

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“…It is worth mentioning that although ICER was comparable with other countries, effects in terms of mean QALY and LYG were better in previously published articles compared with our results 8, 9, 19. This inconsistency could be explained by several assumptions: (i) the observed transition probabilities, in particular from LVAD to death (p13), were lower in those studies than in our study.…”

Section: Discussioncontrasting

confidence: 85%

“…(ii) Another topic to highlight is that all these studies were conducted to evaluate the LVAD in BTT settings, suggesting that patients were in a better health status than those who receive LVAD as a DT. In Clarke et al .,8 13.2% of patients presented with minimal heart failure and slight limitation of physical activity (NYHA II) at the implantation. In our analysis, BTT and DT patients were pooled; no distinction in the database was possible.…”

Section: Discussionmentioning

confidence: 97%

“…Obviously, the USA has a less parsimonious approach than France, with healthcare expenditure per capita in 2014 almost twice the French level. The favourable ICER observed in the UK, which is mostly a result of the efficiency (mean 5.4 LYG), could be explained by less severe cases included in the model: only 58.1% of patients presented with severe cardiovascular disease (NYHA IV), 38.7% moderately severe (NYHA III), and 13.2% (NYHA II) minimal 8. Of note, based on our own experience, all patients had a NYHA of Class IV at LVAD implantation, which reflects the clinical practice in France.…”

Section: Discussionmentioning

confidence: 99%

“…Figure 1 shows the Markov models that were used, and Figure 2 shows the decision model. For ‘LVAD’ group, we applied a previously used economic model, a semi‐Markov multistate model with 1 month cycle, in which each patient exists in one of the three mutually exclusive states8, 9, 18, 19: (i) alive with LVAD, (ii) alive after HTx, and (iii) dead. Each month, each state is associated with a utility value, resource use, and costs components.…”

Section: Methodsmentioning

confidence: 99%

“…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%

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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

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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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Tadmouri¹,

Blomkvist²,

Landais³

et al. 2017

ESC Heart Failure

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Cost‐Effectiveness of Remote Cardiac Monitoring With theCardioMEMSHeart Failure System

Schmier

Ong

Fonarow

2017

Clinical Cardiology

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Heart failure (HF) is a leading cause of cardiovascular mortality in the United States and presents a substantial economic burden. A recently approved implantable wireless pulmonary artery pressure remote monitor, the CardioMEMS HF System, has been shown to be effective in reducing hospitalizations among New York Heart Association (NYHA) class III HF patients. The objective of this study was to estimate the cost‐effectiveness of this remote monitoring technology compared to standard of care treatment for HF. A Markov cohort model relying on the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients) clinical trial for mortality and hospitalization data, published sources for cost data, and a mix of CHAMPION data and published sources for utility data, was developed. The model compares outcomes over 5 years for implanted vs standard of care patients, allowing patients to accrue costs and utilities while they remain alive. Sensitivity analyses explored uncertainty in input parameters. The CardioMEMS HF System was found to be cost‐effective, with an incremental cost‐effectiveness ratio of $44,832 per quality‐adjusted life year (QALY). Sensitivity analysis found the model was sensitive to the device cost and to whether mortality benefits were sustained, although there were no scenarios in which the cost/QALY exceeded $100,000. Compared with standard of care, the CardioMEMS HF System was cost‐effective when leveraging trial data to populate the model.

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Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom

Schueler

Silvestry²,

Cotts

et al. 2021

ESC Heart Failure

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Aims Continuous-flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end-stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequently used as an LVAD indication across other major European countries and the United States, with consistent improvements in quality-of-life and longevity, National Health Service (NHS) England does not currently fund DT, mainly due to concerns over cost-effectiveness. On the basis of the recently published ENDURANCE Supplemental Trial studying DT patients, we assessed for the first time the cost-effectiveness of DT LVADs compared with medical management (MM) in the NHS England. Methods and resultsWe developed a Markov multiple-state economic model using NHS cost data. LVAD survival and adverse event rates were derived from the ENDURANCE Supplemental Trial. MM survival was based on Seattle Heart Failure Model estimates in the absence of contemporary clinical trials for this population. Incremental cost-effectiveness ratios (ICERs) were calculated over a lifetime horizon. A discount rate of 3.5% per year was applied to costs and benefits. Deterministic ICER was £46 207 per quality-adjusted life year (QALY). Costs and utilities were £204 022 and 3.27 QALYs for the LVAD arm vs. £77 790 and 0.54 QALYs for the MM arm. Sensitivity analyses confirmed robustness of the primary analysis. Conclusions The implantation of the HeartWare ™ HVAD ™ System in patients ineligible for cardiac transplantation as DT is a cost-effective therapy in the NHS England healthcare system under the end-of-life willingness-to-pay threshold of £50 000/QALY, which applies for VAD patients.

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Cost-effectiveness of left ventricular assist devices (LVADs) for patients with advanced heart failure: Analysis of the British NHS bridge to transplant (BTT) program

Cited by 52 publications

References 20 publications

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

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

Cost‐Effectiveness of Remote Cardiac Monitoring With theCardioMEMSHeart Failure System

Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom

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