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Comparative cost-effectiveness of the HeartWare versus HeartMate II left ventricular assist devices used in the United Kingdom National Health Service bridge-to-transplant program for patients with heart failure

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Pulikottil-Jacob, Ruth, Suri, Gaurav, Connock, M., Kandala, Ngianga-Bakwin, Sutcliffe, P. (Paul), Maheswaran, Hendramoorthy, Banner, Nicholas R. and Clarke, Aileen (2014) Comparative cost-effectiveness of the HeartWare versus HeartMate II left ventricular assist devices used in the United Kingdom National Health Service bridge-to-transplant program for patients with heart failure. The Journal of Heart and Lung Transplantation, Volume 33 (Number 4). pp. 350-358. doi:10.1016/j.healun.2014.01.003 ISSN 1053-2498.

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Official URL: http://dx.doi.org/10.1016/j.healun.2014.01.003

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Abstract

Background:
Patients with advanced heart failure may receive a left ventricular assist device (LVAD) as part of a bridge-to-transplant (BTT) strategy. The United Kingdom National Health Service (UK NHS) has financed a BTT program in which the predominant LVADs used have been the HeartMate II (HM II; Thoratec, Pleasanton, CA) and HeartWare (HW; HeartWare International, Inc. Framingham, MA). We aimed to compare the cost-effectiveness of the use of these within the NHS program.

Methods:
Individual patient data from the UK NHS Blood and Transplant Data Base were analyzed with Kaplan-Meier and competing outcomes methodologies. Outcomes were time to death, time to heart transplant (HT), and cumulative incidences of HT, death on LVAD support, and LVAD explantation. A semi-Markov multistate economic model was built to assess cost-effectiveness. The perspective was from the NHS, discount rates were 3.5%. Outcomes were quality-adjusted life-years (QALYs) and incremental cost (2011 prices in GB£) per QALY (ICER) for HW vs HM II.

Results:
Survival was better with HW support than with HM II. Cumulative incidence of HT was low for both groups (11% at ~2 years). HW patients accrued 4.99 lifetime QALYs costing £258,913 ($410,970), HM II patients accrued 3.84 QALYs costing £231,871 ($368,048); deterministic and probabilistic ICERs for HW vs HM II were £23,530 ($37,349) and £20,799 ($33,014), respectively.

Conclusions:
Patients In the UK BTT program who received the HW LVAD had a better clinical outcome than those who received the HM II, and the HW was more cost-effective. This result needs to be reassessed in a randomized controlled trial comparing the 2 devices.

Item Type: Journal Article
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title: The Journal of Heart and Lung Transplantation
Publisher: Elsevier Inc
ISSN: 1053-2498
Official Date: April 2014
Dates:
DateEvent
April 2014Published
21 January 2014Available
Volume: Volume 33
Number: Number 4
Page Range: pp. 350-358
DOI: 10.1016/j.healun.2014.01.003
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access

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