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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Cost-effectiveness of left ventricular assist devices (LVADs) for patients with advanced heart failure: Analysis of the British NHS bridge to transplant (BTT) program
International Journal of Cardiology, Volume 171, No. 3, Year 2014
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Description
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 £80,569 ($127,887) at 2011 prices and delivered greater benefit than medical management. The estimated probabilistic incremental cost-effectiveness ratio (ICER) was £53,527 ($84,963)/QALY (95%CI: £31,802-£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 £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 £20,000 to £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. © 2013 The Authors.
Authors & Co-Authors
Clarke, Aileen E.
United Kingdom, Coventry
University of Warwick
Pulikottil-Jacob, Ruth
United Kingdom, Coventry
University of Warwick
Connock, Martin J.
United Kingdom, Coventry
University of Warwick
Kandala, Ngianga Bakwin
United Kingdom, Coventry
University of Warwick
Maheswaran, Hendramoorthy
United Kingdom, Coventry
University of Warwick
Banner, Nicholas Robert
United Kingdom, London
Imperial College London
Sutcliffe, Paul A.
United Kingdom, Coventry
University of Warwick
Statistics
Citations: 43
Authors: 7
Affiliations: 2
Identifiers
Doi:
10.1016/j.ijcard.2013.12.015
ISSN:
18741754
Research Areas
Health System And Policy
Study Design
Randomised Control Trial
Cross Sectional Study