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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
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 |
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| Journal or Publication Title: | The Journal of Heart and Lung Transplantation | ||||||
| Publisher: | Elsevier Inc | ||||||
| ISSN: | 1053-2498 | ||||||
| Official Date: | April 2014 | ||||||
| Dates: |
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| 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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