Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom
Abstract Aims Continuous‐flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end‐stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequent...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-08-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13401 |
| _version_ | 1818906325205123072 |
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| author | Stephan Schueler Scott C. Silvestry William G. Cotts Mark S. Slaughter Wayne C. Levy Richard K. Cheng Jennifer A. Beckman Jonas Villinger Eleni Ismyrloglou Stelios I. Tsintzos Claudius Mahr |
| author_facet | Stephan Schueler Scott C. Silvestry William G. Cotts Mark S. Slaughter Wayne C. Levy Richard K. Cheng Jennifer A. Beckman Jonas Villinger Eleni Ismyrloglou Stelios I. Tsintzos Claudius Mahr |
| author_sort | Stephan Schueler |
| collection | DOAJ |
| description | Abstract Aims Continuous‐flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end‐stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequently used as an LVAD indication across other major European countries and the United States, with consistent improvements in quality‐of‐life and longevity, National Health Service (NHS) England does not currently fund DT, mainly due to concerns over cost‐effectiveness. On the basis of the recently published ENDURANCE Supplemental Trial studying DT patients, we assessed for the first time the cost‐effectiveness of DT LVADs compared with medical management (MM) in the NHS England. Methods and results We developed a Markov multiple‐state economic model using NHS cost data. LVAD survival and adverse event rates were derived from the ENDURANCE Supplemental Trial. MM survival was based on Seattle Heart Failure Model estimates in the absence of contemporary clinical trials for this population. Incremental cost‐effectiveness ratios (ICERs) were calculated over a lifetime horizon. A discount rate of 3.5% per year was applied to costs and benefits. Deterministic ICER was £46 207 per quality‐adjusted life year (QALY). Costs and utilities were £204 022 and 3.27 QALYs for the LVAD arm vs. £77 790 and 0.54 QALYs for the MM arm. Sensitivity analyses confirmed robustness of the primary analysis. Conclusions The implantation of the HeartWare™ HVAD™ System in patients ineligible for cardiac transplantation as DT is a cost‐effective therapy in the NHS England healthcare system under the end‐of‐life willingness‐to‐pay threshold of £50 000/QALY, which applies for VAD patients. |
| first_indexed | 2024-12-19T21:37:26Z |
| format | Article |
| id | doaj.art-ca3d8120b593478db3d145f7b0a24991 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-19T21:37:26Z |
| publishDate | 2021-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-ca3d8120b593478db3d145f7b0a249912022-12-21T20:04:45ZengWileyESC Heart Failure2055-58222021-08-01843049305710.1002/ehf2.13401Cost‐effectiveness of left ventricular assist devices as destination therapy in the United KingdomStephan Schueler0Scott C. Silvestry1William G. Cotts2Mark S. Slaughter3Wayne C. Levy4Richard K. Cheng5Jennifer A. Beckman6Jonas Villinger7Eleni Ismyrloglou8Stelios I. Tsintzos9Claudius Mahr10Cardiothoracic Surgery Freeman Hospital Newcastle UKCardiothoracic Surgery Advent Health Transplant Institute Orlando FL USAHeart Transplantation and Mechanical Assistance Advocate Christ Medical Center Oak Lawn IL USACardiovascular and Thoracic Surgery University of Louisville Louisville KY USACardiology University of Washington Seattle WA USACardiology University of Washington Seattle WA USACardiology University of Washington Seattle WA USAMedtronic International Trading Sarl Tolochenaz SwitzerlandMedtronic Bakken Research Center B.V. Maastricht The NetherlandsMedtronic International Trading Sarl Tolochenaz SwitzerlandCardiology University of Washington Seattle WA USAAbstract Aims Continuous‐flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end‐stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequently used as an LVAD indication across other major European countries and the United States, with consistent improvements in quality‐of‐life and longevity, National Health Service (NHS) England does not currently fund DT, mainly due to concerns over cost‐effectiveness. On the basis of the recently published ENDURANCE Supplemental Trial studying DT patients, we assessed for the first time the cost‐effectiveness of DT LVADs compared with medical management (MM) in the NHS England. Methods and results We developed a Markov multiple‐state economic model using NHS cost data. LVAD survival and adverse event rates were derived from the ENDURANCE Supplemental Trial. MM survival was based on Seattle Heart Failure Model estimates in the absence of contemporary clinical trials for this population. Incremental cost‐effectiveness ratios (ICERs) were calculated over a lifetime horizon. A discount rate of 3.5% per year was applied to costs and benefits. Deterministic ICER was £46 207 per quality‐adjusted life year (QALY). Costs and utilities were £204 022 and 3.27 QALYs for the LVAD arm vs. £77 790 and 0.54 QALYs for the MM arm. Sensitivity analyses confirmed robustness of the primary analysis. Conclusions The implantation of the HeartWare™ HVAD™ System in patients ineligible for cardiac transplantation as DT is a cost‐effective therapy in the NHS England healthcare system under the end‐of‐life willingness‐to‐pay threshold of £50 000/QALY, which applies for VAD patients.https://doi.org/10.1002/ehf2.13401Mechanical circulatory supportVentricular assist deviceDestination therapyCost‐effectiveness |
| spellingShingle | Stephan Schueler Scott C. Silvestry William G. Cotts Mark S. Slaughter Wayne C. Levy Richard K. Cheng Jennifer A. Beckman Jonas Villinger Eleni Ismyrloglou Stelios I. Tsintzos Claudius Mahr Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom ESC Heart Failure Mechanical circulatory support Ventricular assist device Destination therapy Cost‐effectiveness |
| title | Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom |
| title_full | Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom |
| title_fullStr | Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom |
| title_full_unstemmed | Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom |
| title_short | Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom |
| title_sort | cost effectiveness of left ventricular assist devices as destination therapy in the united kingdom |
| topic | Mechanical circulatory support Ventricular assist device Destination therapy Cost‐effectiveness |
| url | https://doi.org/10.1002/ehf2.13401 |
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