- 作者：Aileen Clarke ; Ruth Pulikottil-Jacob ; Martin Connock ; Gaurav Suri ; Ngianga-Bakwin K ; ala ; Hendramoorthy Maheswaran ; Nicholas R. Banner ; Paul Sutcliffe
- 关键词：Left ventricular assist device ; Heart failure ; Comparative cost-effectiveness
- 刊名：International Journal of Cardiology
- 出版年：15 February, 2014
- 年：2014
- 卷：171
- 期：3
- 页码：338-345
- 全文大小：656 K
Background
A previous cost-effectiveness analysis showed that bridge to transplant (BTT) with early design left ventricular assist devices (LVADs) for advanced heart failure was more expensive than medical management while appearing less beneficial.Older LVADs were pulsatile, but current second and third generation LVADs are continuous flow pumps. This study aimed to estimate comparative cost-effectiveness of BTT with durable implantable continuous flow LVADs compared to medical management in the British NHS.
Methods and results
A semi-Markov multi-state economic model was built using NHS costs data and patient data in the British NHS Blood and Transplant Database (BTDB). Quality-adjusted life years (QALYs) and incremental costs per QALY were calculated for patients receiving LVADs compared to those receiving inotrope supported medical management. LVADs cost 拢80,569 ($127,887) at 2011 prices and delivered greater benefit than medical management. The estimated probabilistic incremental cost-effectiveness ratio (ICER) was 拢53,527 ($84,963)/QALY (95%CI: 拢31,802-拢94,853; $50,479-$150,560) (over a lifetime horizon). Estimates were sensitive to choice of comparator population, relative likelihood of receiving a heart transplant, time to transplant, and LVAD costs. Reducing the device cost by 15% decreased the ICER to 拢50,106 ($79,533)/QALY.
Conclusions
Durable implantable continuous flow LVADs deliver greater benefits at higher costs than medical management in Britain. At the current UK threshold of 拢20,000 to 拢30,000/QALY LVADs are not cost effective but the ICER now begins to approach that of an intervention for end of life care recently recommended by the British NHS. Cost-effectiveness estimates are hampered by the lack of randomized trials.