Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy
Girling, Alan J., Freeman, Guy, Gordon, Jason P., Poole-Wilson, Philip, Scott, David A. and Lilford, 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, Vol.23 (No.2). pp. 269-277. ISSN 0266-4623
WRAP_Freeman_Modeling_payback.pdf - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Official URL: http://dx.doi.org/10.1017/S0266462307070365
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-generation 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 (.2 percent) for devices costing as much as £60,000. 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, the value of the survival information can readily justify investment in further trials.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RA Public aspects of medicine|
|Divisions:||Faculty of Science > Statistics|
|Library of Congress Subject Headings (LCSH):||Heart -- Left ventricle -- Surgery, Medical care, Cost of -- Great Britain, Bayesian statistical decision theory, Medical economics|
|Journal or Publication Title:||International Journal of Technology Assessment in Health Care|
|Publisher:||Cambridge University Press|
|Official Date:||16 April 2007|
|Page Range:||pp. 269-277|
|Access rights to Published version:||Open Access|
|Funder:||Engineering and Physical Sciences Research Council (EPSRC)|
|Grant number:||GR/S29874/01 (EPSRC)|
1. Ades, AE, Lu, G, Claxton, K. Expected value of sample information calculations in medical decision modeling. Med Decis Making. 2004; 24: 207–227.
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