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Faldu P, Sharma K, Sharma S, Ramani S, Dadhania N, Konat A. Commentary: Cost-Effectiveness of Left Ventricular Assist Devices as Destination Therapy in the United Kingdom. Front Cardiovasc Med 2022; 9:916588. [PMID: 35898270 PMCID: PMC9312126 DOI: 10.3389/fcvm.2022.916588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Priyansh Faldu
- MBBS Intern, B.J. Medical College and Civil Hospital, Ahmedabad, India
| | - Kamal Sharma
- Department of Cardiology, SAL Hospital, Ahmedabad, India
- *Correspondence: Kamal Sharma
| | - Shaival Sharma
- MBBS Intern, B.J. Medical College and Civil Hospital, Ahmedabad, India
| | - Smeet Ramani
- MBBS Intern, B.J. Medical College and Civil Hospital, Ahmedabad, India
| | - Nain Dadhania
- MBBS Intern, B.J. Medical College and Civil Hospital, Ahmedabad, India
| | - Ashwati Konat
- Department of Zoology, Biomedical Technology and Human Genetics, Gujarat University, Ahmedabad, India
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Chambers JD, Silver MC, Berklein FC, Cohen JT, Neumann PJ. Are Medical Devices Cost-Effective? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:235-241. [PMID: 34820784 DOI: 10.1007/s40258-021-00698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Medical devices can offer important therapeutic advances but, as for any medical interventions, there are questions about their costs and benefits. We examined health benefits and costs for pre-market approved (PMA) devices approved by the US Food and Drug Administration (FDA) (1999-2015), grouping them by generic category (e.g., drug-eluting stents) and indication. METHODS We searched PubMed for incremental health gain estimates [measured in quality-adjusted life-years (QALYs)] and incremental costs for each device category compared to previously available treatments. We calculated incremental cost-effectiveness ratios by dividing the average incremental costs by the average incremental QALY gains. In sensitivity analysis, we repeated the analysis when excluding industry-funded studies. RESULTS We identified at least one relevant cost-utility or comparative-effectiveness study for 88 devices (15.9% of non-cosmetic devices approved from 1999 to 2015), and at least one device across 53 (26.2%) generic categories. The median (mean) incremental cost across generic device categories was $1701 ($13,320). The median (mean) incremental health gain across generic device categories was 0.13 (0.46) QALYs. We found that cost-effectiveness ratios for 36 of 53 (68%) and 43 of 53 (81%) device categories fell below (were more favorable than) $50,000 and $150,000 per QALY, respectively. Results were roughly similar when we excluded industry-funded studies. CONCLUSIONS We found that roughly one-quarter of the major PMA medical device categories have published cost-effectiveness evidence accessible through a large, publicly available database. Available evidence suggests that devices generally offer good value, as judged relative to established cost-effectiveness benchmarks.
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Affiliation(s)
- James D Chambers
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, 35 Kneeland St., Boston, MA, 02111, USA.
| | - Madison C Silver
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, 35 Kneeland St., Boston, MA, 02111, USA
| | - Flora C Berklein
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, 35 Kneeland St., Boston, MA, 02111, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, 35 Kneeland St., Boston, MA, 02111, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, 35 Kneeland St., Boston, MA, 02111, USA
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3
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Ex-vivo lung perfusion therapies. Curr Opin Organ Transplant 2022; 27:204-210. [DOI: 10.1097/mot.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kannojiya V, Das AK, Das PK. Comparative assessment of different versions of axial and centrifugal LVADs: A review. Artif Organs 2021; 45:665-681. [PMID: 33434332 DOI: 10.1111/aor.13914] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/18/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
Continuous-flow left ventricular assist devices (LVADs) have gained tremendous acceptance for the treatment of end-stage heart failure patients. Among different versions, axial flow and centrifugal flow LVADs have shown remarkable potential for clinical implants. It is also very crucial to know which device serves its purpose better to treat heart failure patients. A thorough comparison of axial and centrifugal LVADs, which may guide doctors in deciding before the implant, still lacks in the literature. In this work, an assessment of axial and centrifugal LVADs has been made to suggest a better device by comparing their engineering, clinical, and technological development of design aspects. Hydrodynamic and hemodynamic aspects for both types of pumps are discussed along with their biocompatibility, bearing types, and sizes. It has been observed numerically that centrifugal LVADs perform better over axial LVADs in every engineering aspect like higher hydraulic efficiency, better characteristics curve, lesser power intake, and also lesser blood damage. However, the clinical outcomes suggest that centrifugal LVADs experience higher events of infections, renal, and respiratory dysfunction. In contrast, axial LVADs encountered higher bleeding and cardiac arrhythmia. Moreover, recent technological developments suggested that magnetic type bearings along with biocompatible coating improve the life of LVADs.
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Affiliation(s)
- Vikas Kannojiya
- Mechanical and Industrial Engineering Department, IIT Roorkee, Roorkee, India
| | - Arup Kumar Das
- Mechanical and Industrial Engineering Department, IIT Roorkee, Roorkee, India
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5
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Armoiry X, Obadia JF, Auguste P, Connock M. Conflicting findings between the Mitra-Fr and the Coapt trials: Implications regarding the cost-effectiveness of percutaneous repair for heart failure patients with severe secondary mitral regurgitation. PLoS One 2020; 15:e0241361. [PMID: 33166308 PMCID: PMC7652317 DOI: 10.1371/journal.pone.0241361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Two randomized controlled trials (RCTs), Mitra-Fr and Coapt, evaluating the benefit of percutaneous repair (PR) for heart failure (HF) patients with severe mitral regurgitation, have led to conflicting results. We aimed to evaluate the impact of these trial results on the cost-effectiveness of PR using effectiveness inputs from the two RCTs. METHODS We developed a time varying Markov type model with three mutually exclusive health states: alive without HF hospitalisation, alive with HF hospitalisation, and dead. Clinically plausible extrapolations beyond observed data were obtained by developing parametric modelling for overall survival and HF hospitalisations using published data from each trial. We adopted the perspective of the French Health System and used a 30-year time horizon. Results were expressed as € / quality-adjusted life year (QALY) gained using utility inputs from literature. FINDINGS Results are presented using treatment efficacy measures from Mitra-F and Coapt trials respectively. With the Mitra-Fr data, after annual discounting, the base case model generated an incremental 0.00387 QALY at a cost of €25,010, yielding an incremental cost effectiveness ratio (ICER) of €6,467,032 / QALY. The model was sensitive to changes made to model inputs. There was no potential of PR being cost-effective. With the Coapt data, the model generated 1.19 QALY gain at a cost of €26,130 yielding an ICER of €21,918 / QALY and at a threshold of >€50,000/QALY PR had a probability of 1 of being cost-effective. IMPLICATIONS Cost effectiveness results were conflicting; reconciling differences between trials is a priority and could promote optimal cost effectiveness analyses and resource allocation.
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Affiliation(s)
- Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/Edouard Herriot Hospital, Pharmacy Department, University of Lyon, Lyon, France
- * E-mail:
| | - Jean-François Obadia
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Peter Auguste
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Martin Connock
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Bowen RES, Graetz TJ, Emmert DA, Avidan MS. Statistics of heart failure and mechanical circulatory support in 2020. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:827. [PMID: 32793672 PMCID: PMC7396255 DOI: 10.21037/atm-20-1127] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Heart failure is increasing in prevalence, with approximately 26 million patients affected worldwide. This represents a significant cause of morbidity and mortality. Statistics regarding heart failure patient age, hospitalization likelihood, and mortality differ significantly by country. Heart failure patients are typically classified by ejection fraction, with distinct phenotypes associated with reduced ejection fraction (rEF) or preserved ejection fraction (pEF). Heart failure has a significant financial impact related to hospitalization, medication, and procedural expenses. The costs of heart failure also extend to the reduced quality of life conferred by heart failure symptoms. Management of heart failure includes a variety of interventions, including mechanical circulatory support (MCS). MCS, including left ventricular assist devices (LVADs), right ventricular assist devices (RVADs) and extracorporeal membrane oxygenation (ECMO), has been a means of managing end stage heart failure. Given the relative scarcity of transplant organs, the utilization of MCS, particularly as a bridge to transplantation (BTT) has grown significantly. In this review, we discuss statistics related to heart failure and MCS. We evaluate how patients are classified and examine global trends and regional differences. We then address MCS therapies, the costs associated with heart failure, the impact of heart failure on patient quality of life, and data regarding morbidity and mortality.
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Affiliation(s)
- Robert E S Bowen
- Department of Anesthesiology, Washington University, Saint Louis, MO, USA
| | - Thomas J Graetz
- Department of Anesthesiology, Washington University, Saint Louis, MO, USA
| | - Daniel A Emmert
- Department of Anesthesiology, Washington University, Saint Louis, MO, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University, Saint Louis, MO, USA
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Fontenay S, Catarino L, Snoussi S, van den Brink H, Pineau J, Prognon P, Martelli N. Quality of economic evaluations of ventricular assist devices: A systematic review. Int J Technol Assess Health Care 2020; 36:1-8. [PMID: 32618521 DOI: 10.1017/s0266462320000409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Because of a lack of suitable heart donors, alternatives to transplantation are required. These alternatives can have high costs. The aim of this study was to perform a systematic review of cost-effectiveness studies of ventricular assist devices (VADs) and to assess the level of evidence of relevant studies. The purpose was not to present economic findings. METHODS A systematic review was performed using four electronic databases to identify health economic evaluation studies dealing with VADs. The methodological quality and reporting quality of the studies was assessed using three different tools, the Drummond, Cooper, and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklists. RESULTS Of the 1,258 publications identified, thirteen articles were included in this review. Twelve studies were cost-utility analyses and one was a cost-effectiveness analysis. According to the Cooper hierarchy scale, the quality of the data used was heterogeneous. The level of evidence used for clinical effect sizes, safety data, and baseline clinical data was of poor quality. In contrast, cost data were of high quality in most studies. Quality of reporting varied between studies, with an average score of 17.4 (range 15-19) according to the CHEERS checklist. CONCLUSION The current study shows that the quality of clinical data used in economic evaluations of VADs is rather poor in general. This is a concern that deserves greater attention in the process of health technology assessment of medical devices.
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Affiliation(s)
- Sarah Fontenay
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
| | - Lionel Catarino
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
| | - Soumeya Snoussi
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
| | | | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
| | - Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
- Université Paris-Saclay GRADES, 92290Châtenay-Malabry, France
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Saing S, van der Linden N, Hayward C, Goodall S. Why is There Discordance between the Reimbursement of High-Cost 'Life-Extending' Pharmaceuticals and Medical Devices? The Funding of Ventricular Assist Devices in Australia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:421-431. [PMID: 30906972 DOI: 10.1007/s40258-019-00470-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
New health technologies often yield health benefits, but often at a high cost. In Australia, the processes for public reimbursement of high-cost pharmaceuticals and medical devices are different, potentially resulting in inequity in support for new therapies. We explore how reimbursement is different for medical devices compared with pharmaceuticals, including whether higher cost-effectiveness thresholds are accepted for pharmaceuticals. A literature review identified the challenges of economic evaluations for medical devices compared with pharmaceuticals. We used the ventricular assist device as a case study to highlight specific features of medical device funding in Australia. We used existing guidelines to evaluate whether ventricular assist devices would fulfil the requirements for the "Life-Saving Drugs Program", which is usually reserved for expensive life-extending pharmaceutical treatments of serious and rare medical conditions. The challenges in conducting economic evaluations of medical devices include limited data to support effectiveness, device-operator interaction (surgical experience) and incremental innovations (miniaturisation). However, whilst high-cost pharmaceuticals may be funded by a single source (federal government), the funding of high-cost devices is complex and may be funded via a combination of federal, state and private health insurance. Based on the Life-Saving Drugs Program criteria, we found that ventricular assist devices could be funded by a similar mechanism to that which funds high-cost life-extending pharmaceuticals. This article highlights the complexities of medical device reimbursement. Whilst differences in available evidence affect the evaluation process, differences in funding methods contribute to inequitable reimbursement decisions between medical devices and pharmaceuticals.
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Affiliation(s)
- Sopany Saing
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Naomi van der Linden
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Christopher Hayward
- Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
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Abstract
Heart failure is a progressive condition that continues to increase in both incidence and prevalence despite pharmacologic treatment. The high rate of morbidity and mortality associated with advanced heart failure has led to exploration of additional treatments, which include surgical interventions to improve outcomes. Heart transplant remains the gold standard but, because of the persistent donor shortage and increasing number of patients with advanced heart failure, mechanical circulatory support is gaining acceptance and can be used as a bridge to heart transplant for those eligible or as destination therapy.
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Affiliation(s)
- Candice Falls
- Internal Medicine-Cardiology, University of Kentucky, 1000 South Limestone Pavilion A 08.176, Lexington, KY, USA.
| | - Andrew R Kolodziej
- Gill Heart Institute, University of Kentucky, 900 South Limestone, CTW 320, Lexington, KY 40536, USA
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Farrero M, Flores‐Umanzor EJ, Pomar JL, Sagarra J, Santiago E, Perez‐Villa F. Elective or emergency heart transplantation: Cost comparison in a single center. Clin Transplant 2019; 33:e13596. [DOI: 10.1111/ctr.13596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/24/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Marta Farrero
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Eduardo J. Flores‐Umanzor
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Jose Luis Pomar
- Cardiovascular Surgery Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Joan Sagarra
- Department of Economics, Respiratory Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Evelyn Santiago
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Felix Perez‐Villa
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
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11
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Kwon R, Allen LA, Scherer LD, Thompson JS, Abdel-Maksoud MF, McIlvennan CK, Matlock DD. The Effect of Total Cost Information on Consumer Treatment Decisions: An Experimental Survey. Med Decis Making 2019; 38:584-592. [PMID: 29847252 DOI: 10.1177/0272989x18773718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unrestrained use of expensive, high-risk interventions runs counter to the idea of a limited medical commons. OBJECTIVE To examine the effect of displaying the total first-year cost of implanting a left ventricular assist device (LVAD) on a hypothetical treatment decision and whether this effect differs when choosing for oneself versus for another person. DESIGN We conducted an online survey in February 2016. The survey described the clinical course of end-stage heart failure and the risks and benefits of an LVAD. Participants were randomized to 1 of 4 scenarios, which varied by patient identity (oneself versus another person) and description of total cost. MEASUREMENTS This study measured acceptance of LVAD implantation. Reasoning and attitudes were secondarily explored. RESULTS We received 1211 valid responses. The mean age was 38.3 y (±12.8); 53.5% were female and 84.4% were white. Participants were more likely to accept an LVAD when shown the total cost (66.2% v. 58.0%, P = 0.003) or when choosing for another (68.0 % v. 56.4%, P < 0.001). Open-ended responses indicated that acceptors wanted to extend survival while decliners feared poor quality of life with LVAD therapy. Acceptors and decliners agreed that consumers can help lower the cost of health care, but decliners were more likely to consider cost when making health care decisions ( P < 0.001). LIMITATIONS Limitations include the use of a hypothetical scenario, the use of paid participants, and differences between the respondents and the typical patient facing an LVAD decision. CONCLUSIONS In this sample, being shown the total cost increased the likelihood of accepting an expensive, high-risk treatment. The results question how well consumers understand the relationship between expensive treatments and the commons.
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Affiliation(s)
- Regina Kwon
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laura D Scherer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Jocelyn S Thompson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Colleen K McIlvennan
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel D Matlock
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA.,Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,VA Eastern Colorado Geriatrics Research, Education, and Clinical Center, Denver, CO, USA
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12
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Schmier JK, Patel JD, Leonhard MJ, Midha PA. A Systematic Review of Cost-Effectiveness Analyses of Left Ventricular Assist Devices: Issues and Challenges. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:35-46. [PMID: 30345458 DOI: 10.1007/s40258-018-0439-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Advanced heart failure (HF) can be treated conservatively or aggressively, with left ventricular assist devices (LVADs) and heart transplant (HT) being the most aggressive strategies. OBJECTIVE The goal of this review was to identify, describe, critique and summarize published cost-effectiveness analyses on LVADs for adults with HF. METHODS We conducted a literature search using PubMed and ProQuest DIALOG databases to identify English-language publications from 2006 to 2017 describing cost-effectiveness analyses of LVADs and reviewed them against inclusion criteria. Those that met criteria were obtained for full-text review and abstracted if they continued to meet study requirements. RESULTS A total of 12 cost-effectiveness studies (13 articles) were identified, all of which described models; they were almost evenly split between those examining LVADs as destination therapy (DT) or as bridge to transplant (BTT). Studies were Markov or semi-Markov models with one- or three-month cycles that followed patients until death. Inputs came from a variety of sources, with the REMATCH trial and INTERMACS registry common clinical data sources, although some publications also used data from studies at their own institutions. Costs were derived from standard sources in many studies but from individual hospital data in some. Inputs for health utilities, which were used in 11 of 12 studies, were generally derived from two studies. None of the studies reported a societal perspective, that is, included non-medical costs such as caregiving. CONCLUSIONS No study found LVADs to be cost effective for DT or BTT with base case assumptions, although incremental cost-effectiveness ratios met thresholds for cost effectiveness in some probabilistic analyses. With constant improvements in LVADs and expanding indications, understanding and re-evaluating the cost effectiveness of their use will be critical to making treatment decisions.
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Affiliation(s)
- Jordana K Schmier
- Exponent Inc, 1800 Diagonal Rd., Suite 500, Alexandria, VA, 22314, USA.
| | - Jasmine D Patel
- Exponent Inc, 3440 Market Street, Suite 600, Philadelphia, PA, 19104, USA
| | - Megan J Leonhard
- Exponent, Inc, 15375 SE 30th Place, Suite 250, Bellevue, WA, 98007, USA
| | - Prem A Midha
- Exponent Inc, 3440 Market Street, Suite 600, Philadelphia, PA, 19104, USA
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13
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Ando M, Takeda K, Kurlansky PA, Han J, Garan AR, Topkara VK, Yuzefpolskaya M, Colombo PC, Farr M, Naka Y, Takayama H. Impact of Sharing O Heart With Non-O Recipients: Simulation in the United Network for Organ Sharing Registry. Ann Thorac Surg 2018; 106:1356-1363. [DOI: 10.1016/j.athoracsur.2018.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/13/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
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14
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Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, Gustafsson F, Tsui S, Barge-Caballero E, De Jonge N, Frigerio M, Hamdan R, Hasin T, Hülsmann M, Nalbantgil S, Potena L, Bauersachs J, Gkouziouta A, Ruhparwar A, Ristic AD, Straburzynska-Migaj E, McDonagh T, Seferovic P, Ruschitzka F. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018; 20:1505-1535. [DOI: 10.1002/ejhf.1236] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Maria G. Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC); Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC; La Coruña Spain
| | - Marco Metra
- Cardiology; University of Brescia; Brescia Italy
| | - Lars H. Lund
- Department of Medicine, Unit of Cardiology; Karolinska Institute; Stockholm Sweden
| | - Davor Milicic
- Department for Cardiovascular Diseases; University Hospital Center Zagreb, University of Zagreb; Zagreb Croatia
| | | | | | - Finn Gustafsson
- Department of Cardiology; Rigshospitalet; Copenhagen Denmark
| | - Steven Tsui
- Transplant Unit; Royal Papworth Hospital; Cambridge UK
| | - Eduardo Barge-Caballero
- Complexo Hospitalario Universitario A Coruña (CHUAC); Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC; La Coruña Spain
| | - Nicolaas De Jonge
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Maria Frigerio
- Transplant Center and De Gasperis Cardio Center; Niguarda Hospital; Milan Italy
| | - Righab Hamdan
- Department of Cardiology; Beirut Cardiac Institute; Beirut Lebanon
| | - Tal Hasin
- Jesselson Integrated Heart Center; Shaare Zedek Medical Center; Jerusalem Israel
| | - Martin Hülsmann
- Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | | | - Luciano Potena
- Heart and Lung Transplant Program; Bologna University Hospital; Bologna Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology; Medical School Hannover; Hannover Germany
| | - Aggeliki Gkouziouta
- Heart Failure and Transplant Unit; Onassis Cardiac Surgery Centre; Athens Greece
| | - Arjang Ruhparwar
- Department of Cardiac Surgery; University of Heidelberg; Heidelberg Germany
| | - Arsen D. Ristic
- Department of Cardiology of the Clinical Center of Serbia; Belgrade University School of Medicine; Belgrade Serbia
| | | | | | - Petar Seferovic
- Department of Internal Medicine; Belgrade University School of Medicine and Heart Failure Center, Belgrade University Medical Center; Belgrade Serbia
| | - Frank Ruschitzka
- University Heart Center; University Hospital Zurich; Zurich Switzerland
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15
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The In-Hospital Cost of Ventricular Assist Device Therapy: Implications for Patient Selection. ASAIO J 2018; 63:725-730. [PMID: 28195882 DOI: 10.1097/mat.0000000000000545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ventricular assist device (VAD) therapy is increasingly utilized to support patients in end-stage heart failure. However, VAD programs are resource intensive and demand active monitoring to ensure long-term sustainability. The purpose of this study was to analyze total cost trends of the VAD program at our academic medical center. Retrospective analysis of University of California - Los Angeles's VAD program between 2013 and 2014 was performed. Total in-hospital costs from the date of VAD surgery admission were queried and normalized to a z score. Multivariable linear regression analysis with step-wise elimination was used to model total costs. Overall, 42 patients received a VAD during the study period, with 19 (45%) receiving biventricular support. On univariate analysis, high body mass index, biventricular support, time between VAD implantation and discharge, and total length of hospital stay were correlated with higher costs (all p < 0.02). On multivariable analysis, time between VAD implantation and discharge and biventricular support remained significantly related to total costs (overall R = 0.831, p < 0.001). The time between VAD implantation and discharge and the use of biventricular support were the most predictive factors of total cost in our VAD population. Reducing hospital stay post-VAD implantation is important in minimizing the cost of VAD care.
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Ferket BS, Oxman JM, Iribarne A, Gelijns AC, Moskowitz AJ. Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies. J Thorac Cardiovasc Surg 2018; 155:1671-1681.e11. [PMID: 29338858 PMCID: PMC6497446 DOI: 10.1016/j.jtcvs.2017.11.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Bart S Ferket
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jonathan M Oxman
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Iribarne
- Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, One Medical Center Drive, Lebanon, NH
| | - Annetine C Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alan J Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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17
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Chang HH, Chen PL, Chen IM, Kuo TT, Weng ZC, Huang PJ, Wu NY, Cheng CL. Cost-utility analysis of direct ventricular assist device vs double bridges to heart transplantation in patients with refractory heart failure. Clin Transplant 2017; 31. [PMID: 28944511 DOI: 10.1111/ctr.13124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Abstract
OBJECT This study compared the cost-utility of direct ventricular assist device (VAD) vs double bridges, extracorporeal membrane oxygenation (ECMO) before VAD, to heart transplantation in patients with refractory heart failure. MATERIALS AND METHODS From a health payer perspective, a Markov model was developed. The cycle length was 1 month, and the time horizon was a lifetime. Probabilities and direct cost data were calculated from a nationwide claim database. Utility inputs were adopted from published sources. The utility was expressed as quality-adjusted life years (QALYs). Both costs and utility were discounted by an annual rate of 3%. Deterministic and probabilistic sensitivity analyses were performed to test the stability of the model. RESULTS The direct VAD group had less lifetime costs (USD 95 910 vs USD 129 516) but higher lifetime QALYs than the double bridges group (1.73 vs 0.89). The sensitivity analysis revealed that the direct VAD group consistently had lower cost and higher QALYs during all variations in model parameters. The probability that direct VAD was cost-effective exceeded 75% at any levels of willing-to-pay. CONCLUSION From a health insurance payer perspective, direct VAD bridge to heart transplantation appeared to be more cost-effective than double bridges in patients with refractory heart failure.
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Affiliation(s)
- Hsiao-Huang Chang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Tzu-Ting Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Zen-Chung Weng
- Division of Cardiovascular Surgery, Wei-Gong Memorial Hospital, Miaoli, Taiwan
| | - Pei-Jung Huang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Li Cheng
- Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan
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18
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Tadmouri A, Blomkvist J, Landais C, Seymour J, Azmoun A. Cost-effectiveness of left ventricular assist devices for patients with end-stage heart failure: analysis of the French hospital discharge database. ESC Heart Fail 2017; 5:75-86. [PMID: 28741873 PMCID: PMC5793974 DOI: 10.1002/ehf2.12194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/25/2017] [Accepted: 06/20/2017] [Indexed: 01/20/2023] Open
Abstract
AIMS Although left ventricular assist devices (LVADs) are currently approved for coverage and reimbursement in France, no French cost-effectiveness (CE) data are available to support this decision. This study aimed at estimating the CE of LVAD compared with medical management in the French health system. METHODS AND RESULTS Individual patient data from the 'French hospital discharge database' (Medicalization of information systems program) were analysed using Kaplan-Meier method. Outcomes were time to death, time to heart transplantation (HTx), and time to death after HTx. A micro-costing method was used to calculate the monthly costs extracted from the Program for the Medicalization of Information Systems. A multistate Markov monthly cycle model was developed to assess CE. The analysis over a lifetime horizon was performed from the perspective of the French healthcare payer; discount rates were 4%. Probabilistic and deterministic sensitivity analyses were performed. Outcomes were quality-adjusted life years (QALYs) and incremental CE ratio (ICER). Mean QALY for an LVAD patient was 1.5 at a lifetime cost of €190 739, delivering a probabilistic ICER of €125 580/QALY [95% confidence interval: 105 587 to 150 314]. The sensitivity analysis showed that the ICER was mainly sensitive to two factors: (i) the high acquisition cost of the device and (ii) the device performance in terms of patient survival. CONCLUSIONS Our economic evaluation showed that the use of LVAD in patients with end-stage heart failure yields greater benefit in terms of survival than medical management at an extra lifetime cost exceeding the €100 000/QALY. Technological advances and device costs reduction shall hence lead to an improvement in overall CE.
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Affiliation(s)
- Abir Tadmouri
- Health Economics and Outcome Research (HEOR) Department, ClinSearch, Malakoff, France
| | - Josefin Blomkvist
- Health Economics and Outcome Research (HEOR) Department, ClinSearch, Malakoff, France
| | - Cécile Landais
- Health Economics and Outcome Research (HEOR) Department, ClinSearch, Malakoff, France
| | - Jerome Seymour
- Health Economics and Outcome Research (HEOR) Department, ClinSearch, Malakoff, France
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19
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Magruder JT, Grimm JC, Crawford TC, Tedford RJ, Russell SD, Sciortino CM, Whitman GJ, Shah AS. Survival After Orthotopic Heart Transplantation in Patients Undergoing Bridge to Transplantation With the HeartWare HVAD Versus the Heartmate II. Ann Thorac Surg 2017; 103:1505-1511. [DOI: 10.1016/j.athoracsur.2016.08.060] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/05/2016] [Accepted: 08/15/2016] [Indexed: 11/16/2022]
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20
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Seco M, Zhao DF, Byrom MJ, Wilson MK, Vallely MP, Fraser JF, Bannon PG. Long-term prognosis and cost-effectiveness of left ventricular assist device as bridge to transplantation: A systematic review. Int J Cardiol 2017; 235:22-32. [PMID: 28285802 DOI: 10.1016/j.ijcard.2017.02.137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND This systematic review aimed to evaluate the clinical outcomes and cost-effectiveness of left ventricular assist devices (LVADs) used as bridge to transplantation (BTT), compared to orthotopic heart transplantation (OHT) without a bridge. METHOD Systematic searches were performed in electronic databases with available data extracted from text and digitized figures. Meta-analysis of short and long-term term post-transplantation outcomes was performed with summation of cost-effectiveness analyses. RESULTS Twenty studies reported clinical outcomes of 4575 patients (1083 LVAD BTT and 3492 OHT). Five studies reported cost-effectiveness data on 837 patients (339 VAD BTT and 498 OHT). There was no difference in long-term post-transplantation survival (HR 1.24, 95% CI 1.00-1.54), acute rejection (HR 1.10, 95% CI 0.93-1.30), or chronic rejection and cardiac allograft vasculopathy (HR 0.99, 95% CI 0.73-1.36). No differences were found in 30-day post-operative mortality (OR 0.91, 95% CI 0.42-2.00), stroke (OR 1.64, 95% CI 0.43-6.27), renal failure (OR 1.43, 95% CI 0.58-3.54), bleeding (OR 1.56, 95% CI 0.78-3.13), or infection (OR 2.44, 95% CI 0.81-7.38). Three of the five studies demonstrated incremental cost-effectiveness ratios below the acceptable maximum threshold. The total cost of VAD BTT ranged from $316,078 to $1,025,500, and OHT ranged from $179,051 to $802,200. CONCLUSION LVADs used as BTT did not significantly alter post-transplantation long-term survival, rejection, and post-operative morbidity. LVAD BTT may be cost-effective, particularly in medium and high-risk patients with expected prolonged waiting times, renal dysfunction, and young patients.
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Affiliation(s)
- Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Dong Fang Zhao
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia
| | - Michael J Byrom
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia
| | - Michael K Wilson
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Michael P Vallely
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Australia
| | - Paul G Bannon
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia.
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21
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Bienia S, Feider A, Griauzde R, Patel KD, Minhaj MM. CASE 13—2016 Minimally Invasive Left Ventricular Assist Device Insertion Without Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2016; 30:1716-1726. [DOI: 10.1053/j.jvca.2015.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Indexed: 11/11/2022]
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22
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Prinzing A, Herold U, Berkefeld A, Krane M, Lange R, Voss B. Left ventricular assist devices-current state and perspectives. J Thorac Dis 2016; 8:E660-6. [PMID: 27621895 DOI: 10.21037/jtd.2016.07.13] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mechanical circulatory support devices have become an important treatment tool for severe acute and chronic heart failure, since heart transplantation cannot meet the demands because of a lack of available donor organs. Since implantation of the first ventricular assist device a constant development of the suitability of these devices has been made. This review will introduce different generations of left ventricular assist devices (LVAD) and elaborate on clinical indications, risk stratification and current literature.
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Affiliation(s)
- Anatol Prinzing
- Department of Cardiovascular Surgery, Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
| | - Ulf Herold
- Department of Cardiovascular Surgery, Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
| | - Anna Berkefeld
- I. Medizinische Klinik der Technischen Universität München, Munich, Germany
| | - Markus Krane
- Department of Cardiovascular Surgery, Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany; ; DZHK (German Center for Cardiovascular Research) - partner site Munich HeartAlliance, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany; ; DZHK (German Center for Cardiovascular Research) - partner site Munich HeartAlliance, Munich, Germany
| | - Bernhard Voss
- Department of Cardiovascular Surgery, Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
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Mishra V, Fiane AE, Winsnes BA, Geiran O, Sørensen G, Hagen TP, Gude E. Cardiac replacement therapies: outcomes and costs for heart transplantation versus circulatory assist. SCAND CARDIOVASC J 2016; 51:1-7. [PMID: 27248460 DOI: 10.1080/14017431.2016.1196826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Growing number of patients with terminal heart failure and a shortage of heart donors have increased use of short- and long-term mechanical circulatory support (MCS). Few studies have analyzed survival rates and healthcare costs for heart transplantation (HTx), with or without extracorporeal membrane oxygenation (ECMO) and left ventricular assist device (LVAD). DESIGN In a retrospective, single-center study, data were analyzed from patients listed for HTx who died on the waiting list (DWL, n = 12), underwent HTx (n = 206), had ECMO as bridge to HTx (ECHTx, n = 15), or received LVAD treatment, either isolated (LVAD, n = 19) or bridging to HTx (LVADHTx, n = 26) during 2005-2012. Survival and hospital costs were assessed. RESULTS One- and five-year survival rates were 96% and 83% for the LVADHTx group, 92% and 81% for HTx, 70% and 70% for ECHTx, 48% and 36% for LVAD and 0% for the DWL group (overall survival, p < 0.001). Total hospital cost at one year was $102,101 ± 202,604 for DWL, $151,685 ± 86,892 for HTx, $292,078 ± 101,915 for ECHTx, $427,337 ± 365,154 for LVAD, and $600,897 ± 198,109 for LVADHTx. CONCLUSION The LVADHTx and HTx groups showed excellent one- and five-year survival. The combined group of DWL and HTx patients had similar survival to the combined groups of MCS, but use of LVAD pre-transplant quadrupled the cost.
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Affiliation(s)
- Vinod Mishra
- a Department of Finance and Resource Management Unit , Oslo University Hospital , Oslo , Norway.,b Department of Health Management and Health Economics, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Arnt Eltvedt Fiane
- c Department of Cardiothoracic Surgery , Oslo University Hospital , Oslo , Norway.,d Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Benny Adam Winsnes
- a Department of Finance and Resource Management Unit , Oslo University Hospital , Oslo , Norway
| | - Odd Geiran
- c Department of Cardiothoracic Surgery , Oslo University Hospital , Oslo , Norway.,d Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Gro Sørensen
- c Department of Cardiothoracic Surgery , Oslo University Hospital , Oslo , Norway
| | - Terje Per Hagen
- b Department of Health Management and Health Economics, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Einar Gude
- e Department of Cardiology , Oslo University Hospital , Oslo , Norway
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24
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Nunes AJ, MacArthur RGG, Kim D, Singh G, Buchholz H, Chatterley P, Klarenbach SW. A Systematic Review of the Cost-Effectiveness of Long-Term Mechanical Circulatory Support. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:494-504. [PMID: 27325342 DOI: 10.1016/j.jval.2014.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 11/28/2014] [Accepted: 12/09/2014] [Indexed: 06/06/2023]
Abstract
BACKGROUND Mechanical circulatory support (MCS) is an option for the treatment of medically intractable end-stage heart failure. MCS therapy, however, is resource intensive. OBJECTIVE The purpose of this report was to systematically review the MCS cost-effectiveness literature as it pertains to the treatment of adult patients in end-stage heart failure. METHODS We conducted a systematic search and narrative review of available cost- effectiveness and cost-utility analyses of MCS in adult patients with end-stage heart failure. RESULTS Eleven studies analyzing the cost-effectiveness or cost-utility of MCS were identified. Seven studies focused on bridge to transplantation, three studies focused on destination therapy, and one study presented analyses of both strategies. Two articles evaluated the cost-effectiveness of the HeartMate II (Thoratec Corp., Pleasanton, CA). Incremental cost-effectiveness ratios between MCS and medical management ranged between $85,025 and $200,166 for bridge to transplantation and between $87,622 and $1,257,946 for destination therapy (2012 Canadian dollars per quality-adjusted life-year). Sensitivity analyses indicated that improvements in survival and quality of life and reductions in device and initial hospital-stay costs may improve the cost-effectiveness of MCS. CONCLUSIONS Current studies suggest that MCS is likely not cost-effective with reference to generally accepted or explicitly stated thresholds. Refined patient selection, complication rates, achieved quality of life, and device/surgical costs, however, could modify the cost-effectiveness of MCS.
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Affiliation(s)
- Abraham J Nunes
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Roderick G G MacArthur
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Daniel Kim
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Gurmeet Singh
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Holger Buchholz
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | | | - Scott W Klarenbach
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Vanden Eynden F, Antoine M, El Oumeiri B, Chirade ML, Vachiéry JL, Van Nooten GJ. How to cope with a temporarily aborted transplant program: solutions for a prolonged waiting period. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:306. [PMID: 26697466 DOI: 10.3978/j.issn.2305-5839.2015.11.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Due to budgetary restrictions our university heart transplant program came to a standstill to be gradually restarted early 2011. Consequently waiting-times for transplantation increased dramatically beyond the usual 10-15 months. We reviewed the clinical results of this peculiar transplant program over the past 4 years. METHODS Since March 2011 until February 2015, 65 patients (age 48±23 years) were listed for heart transplantation. Eight patients (11%) of whom three in high emergency were transplanted without any form of mechanical assistance. Fifty-one patients required a left ventricular assist device (LVAD) Heartware (Heartware Inc., Miami Lakes, FL, USA) as a bridge-to-transplant due to terminal heart failure. Merely 5 listed patients remain without assistance. RESULTS One patient without assistance and 11 LVAD patients (22%) died on the waiting-list. Meanwhile 10 LVAD patients were transplanted after a 2-year waiting time (770±717 days). Four transplanted patients died of early graft failure none after LVAD explantation. Survival at 1 and 3 years was respectively 78 (72%) and 83 (78%) for transplanted and assisted patients (log-rank P=0.056). Cox multivariable regression analysis identified crash-to-burn patients (P=0.002) and waiting-times over 2 years (P=0.044) as risk factors for early death, while age above 60 (P=0.008) and ischemic aetiology (P=0.029) and pulmonary hypertension (P=0.092) were risk factors for survival. CONCLUSIONS In times of donor shortage mechanical assistance proves very effective as bridge-to-transplant in patients for whom candidacy follows the standard inclusion procedures. In our settings, a steep increase in LVAD implantation served to salvage patients for whom transplantation became jeopardized due to an ever increasing waiting-time. Circulatory LVAD support could be considered as primary therapy in the future.
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Affiliation(s)
- Frédéric Vanden Eynden
- 1 Department of Cardiac Surgery, University Hospital Erasme ULB, Brussels, Belgium ; 2 Faculty of Medicine, University of Ghent, Ghent, Belgium
| | - Martine Antoine
- 1 Department of Cardiac Surgery, University Hospital Erasme ULB, Brussels, Belgium ; 2 Faculty of Medicine, University of Ghent, Ghent, Belgium
| | - Bachar El Oumeiri
- 1 Department of Cardiac Surgery, University Hospital Erasme ULB, Brussels, Belgium ; 2 Faculty of Medicine, University of Ghent, Ghent, Belgium
| | - Marie-Luce Chirade
- 1 Department of Cardiac Surgery, University Hospital Erasme ULB, Brussels, Belgium ; 2 Faculty of Medicine, University of Ghent, Ghent, Belgium
| | - Jean-Luc Vachiéry
- 1 Department of Cardiac Surgery, University Hospital Erasme ULB, Brussels, Belgium ; 2 Faculty of Medicine, University of Ghent, Ghent, Belgium
| | - Guido J Van Nooten
- 1 Department of Cardiac Surgery, University Hospital Erasme ULB, Brussels, Belgium ; 2 Faculty of Medicine, University of Ghent, Ghent, Belgium
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Abstract
For the year 2014, more than 17,000 published references can be found in Pubmed when entering the search term "cardiac surgery". The last year has been characterized by a vivid discussion in the fields where classic cardiac surgery and modern interventional techniques overlap. Specifically, there have been important contributions in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery as well as in the fields of interventional valve therapy. Here, the US core valve trial with the first demonstration of a survival advantage at 1 year with transcatheter valves compared to surgical aortic valve replacement or the 5-year outcome of the SYNTAX trial with significant advantages for bypass surgery has been the landmark. However, in addition to these most visible publications, there have been several highly relevant and interesting contributions. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices) and aortic surgery. This condensed summary will provide the reader with "solid ground" for up-to-date decision-making in cardiac surgery.
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Lushaj EB, Badami A, Osaki S, Murray M, Leverson G, Lozonschi L, Akhter S, Kohmoto T. Impact of age on outcomes following continuous-flow left ventricular assist device implantation. Interact Cardiovasc Thorac Surg 2015; 20:743-8. [DOI: 10.1093/icvts/ivv051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/19/2015] [Indexed: 11/12/2022] Open
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Evans RW, Pagani FD. Economic evaluation in health care: a modern day quagmire. J Heart Lung Transplant 2014; 33:344-6. [PMID: 24661452 DOI: 10.1016/j.healun.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 02/07/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- Roger W Evans
- United Network for the Recruitment of Transplantation Professionals, Rochester, Minnesota
| | - Francis D Pagani
- Center for Circulatory Support and the Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
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