Cost-effectiveness of left-ventricular assist devices as destination therapy for end-stage heart failure
Samson D
Record ID 32004000235
English
Authors' objectives:
This cost-effectiveness analysis addresses the use of left-ventricular assist device (LVAD) destination therapy, compared with optimal medical management, among patients who are not heart transplant candidates.
Authors' recommendations:
The baseline cost-effectiveness analysis, using parameter estimates from published sources, showed that use of LVADs leads to an increase in cost of $802,700 to gain 1 QALY, compared with optimal medical management. Within the range of values used in this analysis, the incremental cost-effectiveness ratio (ICER) was fairly stable amid changes in these variables: utility for New York Heart Association (NYHA) category III/IV; utility discount rate; cost of outpatient care; and cost discount rate, cost of rehospitalization, probability of rehospitalization for LVAD; and probability of rehospitalization for optimal medical management (OMM). Results were more sensitive to variations in utility for NYHA category I/II and the cost of LVAD implantation. ICERs of $500,000/QALY or less depended on improbable assumptions of very low costs for LVAD implantation, usually in combination with extreme values on other variables. This analysis takes a societal perspective; however, some elements of this perspective, such as use of indirect costs, were not strictly followed. Although utilities from a general population would be preferred, the estimates used here from LVAD recipients suffice given the wide range of values surrounding them in the sensitivity analysis. As stated, indirect costs, such as lost wages and costs borne by caretakers, are not included, but as return to work is unlikely for either LVAD or OMM patients, excluding indirect costs would not affect the strategies relative standings in the analysis. The short time horizon should limit the impact of excluding indirect costs.
Authors' methods:
Cost study
Details
Project Status:
Completed
URL for project:
http://www.bcbs.com/blueresources/tec/contact-tec.html
Year Published:
2004
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
United States
MeSH Terms
- Costs and Cost Analysis
- Heart Failure
- Heart-Assist Devices
Contact
Organisation Name:
BlueCross BlueShield Association
Contact Address:
BlueCross BlueShield Association, Technology Evaluation Center, 225 North Michigan Ave, Chicago, Illinois, USA. Tel: 888 832 4321
Contact Name:
tec@bcbsa.com
Contact Email:
tec@bcbsa.com
Copyright:
BlueCross BlueShield Association (BCBS)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.