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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
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Cost-effectiveness analysis of continuous-flow left ventricular assist devices as destination therapy

Joseph G Rogers1, Robin R Bostic, Kuo B Tong

  • 1Division of Cardiology, Duke University, Durham, NC, USA.

Circulation. Heart Failure
|November 5, 2011
PubMed

Insights

Continuous-flow left ventricular assist devices (LVADs) significantly improve survival and quality of life for advanced heart failure patients. These devices offer a more cost-effective solution compared to older pulsatile-flow models.

Area of Science:

  • Cardiology
  • Health Economics
  • Medical Devices

Background:

  • Continuous-flow left ventricular assist devices (LVADs) are prevalent in mechanical circulatory support.
  • The cost-effectiveness of these devices for destination therapy remains largely undetermined.
  • Previous cost-effectiveness estimates exist for older pulsatile-flow devices.

Purpose of the Study:

  • To assess the cost-effectiveness of continuous-flow LVADs for destination therapy.
  • To compare the cost-effectiveness of continuous-flow LVADs against optimal medical management.
  • To compare current continuous-flow LVAD cost-effectiveness with historical pulsatile-flow device data.

Main Methods:

  • A Markov model was utilized to evaluate cost-effectiveness.
  • Data on survival, hospitalization, quality of life, and costs were gathered from clinical trials and hospital claims.
  • Medicare prospective payments informed the estimation of heart failure admission costs.

Main Results:

  • Continuous-flow LVADs resulted in higher 5-year costs ($360,407 vs. $62,856) but improved quality-adjusted life years (1.87 vs. 0.37) and life years (2.42 vs. 0.64) compared to medical management.
  • The incremental cost-effectiveness ratio for continuous-flow LVADs was $198,184 per QALY and $167,208 per LY.
  • This represents a 75% reduction in the incremental cost-effectiveness ratio compared to pulsatile-flow devices ($802,700 per QALY).

Conclusions:

  • Cost-effectiveness for continuous-flow LVADs in destination therapy has substantially improved.
  • Key drivers of improved cost-effectiveness include enhanced survival, better functional status, and reduced implantation costs.
  • Continuous-flow LVADs present a more favorable economic profile than their pulsatile predecessors.
Abstract

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