Cost-Effectiveness of Left Ventricular Assist Devices in Ambulatory Patients With Advanced Heart Failure

This study assessed the cost-effectiveness of left ventricular assist devices (LVADs) as destination therapy in ambulatory patients with advanced heart failure. LVADs improve survival and quality of life in inotrope-dependent heart failure, but data are limited as to their value in less severely ill...

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Veröffentlicht in:JACC. Heart failure Jg. 5; H. 2; S. 110
Hauptverfasser: Baras Shreibati, Jacqueline, Goldhaber-Fiebert, Jeremy D, Banerjee, Dipanjan, Owens, Douglas K, Hlatky, Mark A
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.02.2017
Schlagworte:
Aged
Ambulatory Care - economics
Cardiotonic Agents - economics
Cardiotonic Agents - therapeutic use
Cost-Benefit Analysis
Female
Heart Failure - economics
Heart Failure - therapy
Heart-Assist Devices - economics
Hospitalization - economics
Hospitalization - statistics & numerical data
Humans
Length of Stay
Male
Markov Chains
Middle Aged
Patient Readmission - economics
Patient Readmission - statistics & numerical data
Quality of Life
Quality-Adjusted Life Years
Severity of Illness Index
Survival Rate
United States
heart failure
left ventricular assist device
Medicare
cost-effectiveness analysis
ISSN:2213-1787, 2213-1787
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Zusammenfassung:This study assessed the cost-effectiveness of left ventricular assist devices (LVADs) as destination therapy in ambulatory patients with advanced heart failure. LVADs improve survival and quality of life in inotrope-dependent heart failure, but data are limited as to their value in less severely ill patients. We determined costs of care among Medicare beneficiaries before and after LVAD implantation from 2009 to 2010. We used these costs and efficacy data from published studies in a Markov model to project the incremental cost-effectiveness ratio (ICER) of destination LVAD therapy compared with that of medical management. We discounted costs and benefits at 3% annually and report costs as 2016 U.S. dollars. The mean cost of LVAD implantation was $175,420. The mean cost of readmission was lower before LVAD than after ($12,377 vs. $19,465, respectively; p < 0.001), while monthly outpatient costs were similar ($3,364 vs. $2,974, respectively; p = 0.54). In the lifetime simulation model, LVAD increased quality-adjusted life-years (QALYs) (4.41 vs. 2.67, respectively), readmissions (13.03 vs. 6.35, respectively), and costs ($726,200 vs. $361,800, respectively) compared with medical management, yielding an ICER of $209,400 per QALY gained and $597,400 per life-year gained. These results were sensitive to LVAD readmission rates and outpatient care costs; the ICER would be $86,900 if these parameters were 50% lower. LVADs in non-inotrope-dependent heart failure patients improved quality of life but substantially increased lifetime costs because of frequent readmissions and costly follow-up care. LVADs may provide good value if outpatient costs and adverse events can be reduced.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:2213-1787
2213-1787
DOI:10.1016/j.jchf.2016.09.008