Clarke, Aileen, Pulikottil-Jacob, Ruth, Connock, M., Suri, G., Kandala, Ngianga-Bakwin, Maheswaran, Hendramoorthy, Banner, Nicholas R. and Sutcliffe, P. (Paul) (2014) 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 (Number 3). pp. 338-345. doi:10.1016/j.ijcard.2013.12.015 ISSN 0167-5273.

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Abstract

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.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RD Surgery
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Heart -- Left ventricle , Heart -- Left ventricle -- Surgery, Heart failure , Medical care, Cost of -- Great Britain, Great Britain. National Health Service
Journal or Publication Title:	International Journal of Cardiology
Publisher:	Elsevier Ireland Ltd.
ISSN:	0167-5273
Official Date:	13 February 2014
Dates:	Date Event 13 February 2014 Published 11 December 2013 Accepted 28 June 2013 Submitted
Volume:	Volume 171
Number:	Number 3
Page Range:	pp. 338-345
DOI:	10.1016/j.ijcard.2013.12.015
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	26 December 2015
Date of first compliant Open Access:	26 December 2015
Funder:	NIHR Health Technology Assessment Programme (Great Britain)
Grant number:	12/02/01 (NIHR/HTA)

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