- 作者：Linda D. Sharples ; Matthew Dyer ; Fay Cafferty ; Nikolaos Demiris ; Carol Freeman ; Nicholas R. Banner ; Stephen R. Large ; Steven Tsui ; Noreen Caine ; Martin Buxton
- 刊名：The Journal of Heart and Lung Transplantation
- 出版年：2006
- 期刊代码：161_10532498
- 类别：med
- 出版时间：November 2006
- 卷：25
- 期：11
- 页码：1336-1343
- 文件大小：104 K
Background
The UK Department of Health funds ventricular assist device (VAD) implantation as a bridge to transplantation (BTT) at three centers. The cost-effectiveness of this program has not been established.Methods
All 70 VAD implants for BTT and a consecutive cohort of 71 inotrope-dependent transplant candidates, between April 2002 and December 2004, were prospectively monitored for survival, transplantation, quality of life and resource use. Costs and quality-adjusted life-years were estimated for these groups, and for a hypothetical scenario in which VAD patients would die within 30 days in the absence of the program.
Results
Mean quality-adjusted life-years for a VAD patient was 3.27 at a lifetime cost of £173,841 (US$316,078). The majority of the cost was attributable to the VAD implant (£63,830, US$116,056) and the initial hospital stay in the ITU and ward (£14,500, US$26,364). Inotrope-dependent transplant candidates had mean quality-adjusted life-years of 4.99 at a lifetime cost of £130,905 (US$238,011). The worst clinical scenario resulted in a lifetime cost of £14,400 (US$26,182), based on 1 month in the ICU (mean 15 days). These figures were robust to a range of plausible assumptions.
Conclusions
A lifetime model based on current UK practice demonstrates that BTT VAD patients had significant quality-adjusted life-years, but treatment was expensive when compared with the worst clinical scenario. If device technology improves, costs are reduced, or referral practice changes, results should be re-assessed.