Cost-Effectiveness of Left Ventricular Assist Device for Transplant-Ineligible Patients

Area of Science:

• Health economics
• Cardiovascular medicine
• Medical technology assessment

Background:

• Singapore is evaluating subsidies for left ventricular assist devices (LVADs) for end-stage heart failure (ESHF).
• Economic evidence is crucial for this decision, but no prior cost-effectiveness evaluations exist.
• Transplant-ineligible patients with ESHF often require advanced support like LVADs.

Purpose of the Study:

• To estimate the lifetime cost-effectiveness of LVADs compared to optimal medical management.
• To assess the economic value of LVADs for adult patients with transplant-ineligible ESHF in Singapore.

Main Methods:

• A Markov model simulated survival, adverse events, and hospitalizations for transplant-ineligible ESHF patients.
• Age-adjusted LVAD mortality data and indirect comparisons informed survival estimates.
• Costs were derived from Singaporean billing data and LVAD center charges (2017-2022).

Main Results:

• LVADs yielded an additional 3.45 QALYs at an incremental cost of SGD 404,678, resulting in an ICER of SGD 117,370 per QALY gained.
• For inotrope-dependent patients, the ICER was SGD 106,458/QALY (59% probability of high value), while for inotrope-independent patients, it was SGD 174,798/QALY (19% probability).
• Significant price reductions or mortality hazard decreases were needed for LVADs to be high value in inotrope-independent patients.

Conclusions:

• LVADs appear to be potentially high-value for inotrope-dependent, transplant-ineligible ESHF patients.
• Cost-effectiveness for inotrope-independent patients requires substantial price reductions or improved survival.
• This economic evaluation provides critical data for Singapore's LVAD subsidy considerations.