Comparative cost-effectiveness of the Heart Ware versus Heart Mate II left ventricular assist devices used in the United Kingdom National Health Service bridge-to-transplant program for patients with heart failure



Pulikottil-Jacob, Ruth, Suri, Gaurav, Connock, Martin, Kandala, Ngianga-Bakwin, Sutcliffe, Paul, Maheswaran, Hendramoorthy ORCID: 0000-0002-7375-4845, Banner, Nicholas R and Clarke, Aileen
(2014) Comparative cost-effectiveness of the Heart Ware versus Heart Mate II left ventricular assist devices used in the United Kingdom National Health Service bridge-to-transplant program for patients with heart failure. JOURNAL OF HEART AND LUNG TRANSPLANTATION, 33 (4). pp. 350-358.

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Abstract

<h4>Background</h4>Patients with advanced heart failure may receive a left ventricular assist device (LVAD) as part of a bridge-to-transplant (BTT) strategy. The United Kingdom National Health Service (UK NHS) has financed a BTT program in which the predominant LVADs used have been the HeartMate II (HM II; Thoratec, Pleasanton, CA) and HeartWare (HW; HeartWare International, Inc. Framingham, MA). We aimed to compare the cost-effectiveness of the use of these within the NHS program.<h4>Methods</h4>Individual patient data from the UK NHS Blood and Transplant Data Base were analyzed with Kaplan-Meier and competing outcomes methodologies. Outcomes were time to death, time to heart transplant (HT), and cumulative incidences of HT, death on LVAD support, and LVAD explantation. A semi-Markov multistate economic model was built to assess cost-effectiveness. The perspective was from the NHS, discount rates were 3.5%. Outcomes were quality-adjusted life-years (QALYs) and incremental cost (2011 prices in GB£) per QALY (ICER) for HW vs HM II.<h4>Results</h4>Survival was better with HW support than with HM II. Cumulative incidence of HT was low for both groups (11% at ~2 years). HW patients accrued 4.99 lifetime QALYs costing £258,913 ($410,970), HM II patients accrued 3.84 QALYs costing £231,871 ($368,048); deterministic and probabilistic ICERs for HW vs HM II were £23,530 ($37,349) and £20,799 ($33,014), respectively.<h4>Conclusions</h4>Patients In the UK BTT program who received the HW LVAD had a better clinical outcome than those who received the HM II, and the HW was more cost-effective. This result needs to be reassessed in a randomized controlled trial comparing the 2 devices.

Item Type: Article
Uncontrolled Keywords: left ventricular assist device, heart failure, bridge to transplant, clinical effectiveness, cost-effectiveness analysis, economic model
Depositing User: Symplectic Admin
Date Deposited: 31 Oct 2017 11:50
Last Modified: 19 Jan 2023 06:51
DOI: 10.1016/j.healun.2014.01.003
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3011206