Cost-Effectiveness of Ventricular Assist Device Therapy as a Bridge to Transplantation Compared With Nonbridged Cardiac Recipients

Abstract

Background-Current available treatment options for advanced heart failure include heart transplantation and ventricular assist device (VAD) therapy. This project aimed to evaluate the cost-effectiveness of a bridge-to-transplantation (BTT)-VAD approach relative to direct heart transplantation in transplant-eligible patients. Methods and Results-A Markov model was used to evaluate survival benefits and costs for BTT-VAD versus nonbridged heart transplant recipients. Three different scenarios were considered according to severity of patients' baseline hemodynamic status (high, medium, and low risk). Results are presented in terms of survival, costs, and cost-effectiveness ratio. Sensitivity analyses were used to analyze uncertainty in model estimates. Over a 20-year time horizon, BTT-VAD therapy increased survival at an increased cost relative to nonbridged heart transplant recipients: $100 841more in costs and 1.19 increased life years (LYs) in high-risk patients ($84 964/LY), $112 779 more in costs and 1.14 more LYs ($99 039/LY) in medium-risk patients, and an additional cost of $144 334 and incremental clinical benefit of 1.21 more LYs ($119 574/LY) in low-risk patients. The sensitivity analysis estimated a 59%, 54%, and 43% chance of BTT-VAD therapy being cost-effective for high-, medium-, and low-risk patients at a willingness-to-pay level of $100 000/LY. Subgroup analyses indicated that risk of post-VAD and transplantation complications, waiting time, renal dysfunction, and patient age substantially affected the cost-effectiveness ratio. Conclusions-BTT-VAD therapy is associated with improved survival and increased costs. On the basis of commonlyaccepted willingness-to-pay thresholds, BTT-VAD therapy is likely to be cost-effective relative to nonbridged heart transplantation in specific circumstances. (Circulation. 2013;127:2424-2435.)Key Words: cost-benefit analysis ◼ economics ◼ heart-assist devices ◼ heart failure ◼ heart transplantation © 2013 American Heart Association, Inc.

Long-term prognosis and cost-effectiveness of left ventricular assist device as bridge to transplantation: A systematic review

“…Additional outcomes for analysis of cost-effectiveness included ICERs, total cost, and qualityadjusted life years (QALYs) or life years (LYs) gained for VADs compared to OHT. The cost-effectiveness threshold for VADs was set to $100,000 per QALY or LY, below which VADs are considered cost-effective and thus worth paying for (15)(16)(17).…”

“…derived from government or hospital data (15,22). Time horizons of all studies varied from 20 years (15) to lifetime (6,(22)(23)(24).…”

“…Overall, eight studies compared long-term acute or chronic rejection between LVAD BTT and OHT ( Four studies reported ICERs specifically to gain one additional LY (6,15,23,24). These ranged from $72,475 to…”

Placing a Value on New Technologies

“…Alba and colleagues 10 found that over a 20-year time horizon, using a VAD as a bridge to transplantation increases life expectancy by 1.19 years in high-risk patients at a cost of $100 841, resulting in a cost-effectiveness ratio near $85 000 per life-year gained compared with not using a VAD as a bridge. VADs in lowerrisk patients had worse value with a cost-effectiveness ratio near $120 000 per life-year gained.…”

Most Important Outcomes Research Papers on Device Therapies for Cardiomyopathies

“…12 Lastly, these devices are costly; establishing the cost-effectiveness of these devices is an essential prerequisite in an era of constrained healthcare resources. 13 We focus predominantly on papers that address these challenges in the following topic review for Circulation: Cardiovascular Quality and Outcomes. We have therefore included papers that evaluate outcomes related to (1) implanted cardioverter-defibrillators, (2) cardiac-resynchronization therapy and (3) ventricular assist devices in patients with cardiomyopathies and its common presentations of heart failure and sudden cardiac death.…”