Cost-effectiveness of left ventricular assist devices (LVADs) for patients with advanced heart failure: Analysis of the British NHS bridge to transplant (BTT) program

Clarke, Aileen, Pulikottil-Jacob, Ruth, Connock, Martin, Suri, Gaurav, Kandala, Ngianga-Bakwin, Maheswaran, Hendramoorthy, Banner, Nicholas R and Sutcliffe, Paul (2014) Cost-effectiveness of left ventricular assist devices (LVADs) for patients with advanced heart failure: Analysis of the British NHS bridge to transplant (BTT) program INTERNATIONAL JOURNAL OF CARDIOLOGY, 171 (3). pp. 338-345. ISSN 0167-5273, 1874-1754

Text Cost-effectiveness of left ventricular assist devices (LVADs) for patients with advanced heart failure- Analysis of the British NHS bridge to transplant (BTT) program.pdf - Published version Download (813kB)

Abstract

Background A previous cost-effectiveness analysis showed that bridge to transplant (BTT) with early design left ventricular assist devices (LVADs) for advanced heart failure was more expensive than medical management while appearing less beneficial. Older LVADs were pulsatile, but current second and third generation LVADs are continuous flow pumps. This study aimed to estimate comparative cost-effectiveness of BTT with durable implantable continuous flow LVADs compared to medical management in the British NHS. Methods and results A semi-Markov multi-state economic model was built using NHS costs data and patient data in the British NHS Blood and Transplant Database (BTDB). Quality-adjusted life years (QALYs) and incremental costs per QALY were calculated for patients receiving LVADs compared to those receiving inotrope supported medical management. LVADs cost £80,569 ($127,887) at 2011 prices and delivered greater benefit than medical management. The estimated probabilistic incremental cost-effectiveness ratio (ICER) was £53,527 ($84,963)/QALY (95%CI: £31,802-£94,853; $50,479- $150,560) (over a lifetime horizon). Estimates were sensitive to choice of comparator population, relative likelihood of receiving a heart transplant, time to transplant, and LVAD costs. Reducing the device cost by 15% decreased the ICER to £50,106 ($79,533)/QALY. Conclusions Durable implantable continuous flow LVADs deliver greater benefits at higher costs than medical management in Britain. At the current UK threshold of £20,000 to £30,000/QALY LVADs are not cost effective but the ICER now begins to approach that of an intervention for end of life care recently recommended by the British NHS. Cost-effectiveness estimates are hampered by the lack of randomized trials. © 2013 The Authors.

Item Type:	Article
Uncontrolled Keywords:	Left ventricular assist device, Heart failure, Comparative cost-effectiveness
Depositing User:	Symplectic Admin
Date Deposited:	31 Oct 2017 11:51
Last Modified:	16 Jun 2026 12:59
DOI:	10.1016/j.ijcard.2013.12.015
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3011205
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