Girling, Alan J., Freeman, Guy, Gordon, Jason P., Poole-Wilson, Philip, Scott, David A. and Ford, Richard J.. (2007) Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy. INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, 23 (2). pp. 269-277. ISSN 0266-4623

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Abstract

Objectives: Ongoing developments in design have improved the outlook for left-ventricular assist device (LVAD) implantation as a therapy in end-stage heart failure. Nevertheless, early cost-effectiveness assessments, based on first-generation devices, have not been encouraging. Against this background, we set out (i) to examine the survival benefit that LVADs would need to generate before they could be deemed cost-effective; (ii) to provide insight into the likelihood that this benefit will be achieved; and (iii) from the perspective of a healthcare provider, to assess the value of discovering the actual size of this benefit by means of a Bayesian value of information analysis. Methods: Cost-effectiveness assessments are made from the perspective of the healthcare provider, using current UK norms for the value of a quality-adjusted life-year (QALY). The treatment model is grounded in published analyses of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial of first-generation LVADs, translated into a UK cost setting. The prospects for patient survival with second-gene ration devices is assessed using Bayesian prior distributions, elicited from a group of leading clinicians in the field. Results: Using established thresholds, cost-effectiveness probabilities under these priors are found to be low (similar to.2 percent) for devices costing as much as 60,000 pound. Sensitivity of the conclusions to both device cost and QALY valuation is examined. Conclusions: In the event that the price of the device in use would reduce to 40,000 pound, the value of the survival information can readily justify investment in further trials.

Item Type:	Journal Article
Subjects:	H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine
Journal or Publication Title:	INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE
Publisher:	CAMBRIDGE UNIV PRESS
ISSN:	0266-4623
Date:	2007
Volume:	23
Number:	2
Number of Pages:	9
Page Range:	pp. 269-277
Identification Number:	10.1017/S0266462307070365
Publication Status:	Published
URI:	http://wrap.warwick.ac.uk/id/eprint/32078

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