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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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Schueler S, Silvestry SC, Cotts WG, Slaughter MS, Levy WC, Cheng RK, Beckman JA, Villinger J, Ismyrloglou E, Tsintzos SI, Mahr C. Cost-effectiveness of left ventricular assist devices as destination therapy in the United Kingdom. ESC Heart Fail 2021; 8:3049-3057. [PMID: 34047072 PMCID: PMC8318455 DOI: 10.1002/ehf2.13401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 01/12/2023] Open
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.
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Affiliation(s)
| | - Scott C Silvestry
- Cardiothoracic Surgery, Advent Health Transplant Institute, Orlando, FL, USA
| | - William G Cotts
- Heart Transplantation and Mechanical Assistance, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Mark S Slaughter
- Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Wayne C Levy
- Cardiology, University of Washington, Seattle, WA, USA
| | | | | | - Jonas Villinger
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | | | - Claudius Mahr
- Cardiology, University of Washington, Seattle, WA, USA
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3
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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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Huitema AA, Harkness K, Malik S, Suskin N, McKelvie RS. Therapies for Advanced Heart Failure Patients Ineligible for Heart Transplantation: Beyond Pharmacotherapy. Can J Cardiol 2020; 36:234-243. [DOI: 10.1016/j.cjca.2019.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 12/25/2022] Open
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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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6
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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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7
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Magnetta DA, Kang J, Wearden PD, Smith KJ, Feingold B. Cost-Effectiveness of Ventricular Assist Device Destination Therapy for Advanced Heart Failure in Duchenne Muscular Dystrophy. Pediatr Cardiol 2018; 39:1242-1248. [PMID: 29774392 DOI: 10.1007/s00246-018-1889-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 05/02/2018] [Indexed: 11/28/2022]
Abstract
Destination ventricular assist device therapy (DT-VAD) is well accepted in select adults with medically refractory heart failure (HF) who are not transplant candidates; however, its use in younger patients with progressive diseases is unclear. We sought to evaluate the cost-effectiveness of DT-VAD in Duchenne muscular dystrophy (DMD) patients with advanced HF. We created a Markov-state transition model (5-year horizon) to compare survival, costs, and quality of life (QOL) between medical management and DT-VAD in DMD with advanced HF. Model input parameters were derived from the literature. We used sensitivity analyses to explore uncertainty around model assumptions. DT-VAD had higher costs ($435,602 vs. $125,696), survival (3.13 vs. 0.60 years), and quality-adjusted survival (1.99 vs. 0.26 years) than medical management. The incremental cost-effectiveness ratio (ICER) for DT-VAD was $179,086 per quality-adjusted life year (QALY). In sensitivity analyses that were widely varied to account for uncertainty in model assumptions, the DT-VAD strategy generally remained more costly and effective than medical management. Only when VAD implantation costs were <$113,142 did the DT-VAD strategy fall below the $100,000/QALY willingness-to-pay threshold commonly considered to be "cost-effective." In this exploratory analysis, DT-VAD for patients with DMD and advanced HF exceeded societal expectations for cost-effectiveness but had an ICER similar to the accepted practice of DT-VAD in adult HF patients. While more experience and research in this population is needed, our analysis suggests that DT-VAD for advanced HF in DMD should not be dismissed solely based on cost.
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Affiliation(s)
- Defne A Magnetta
- Pediatrics, Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion Floor 5, Pittsburgh, PA, 15224, USA.
| | - JaHyun Kang
- College of Nursing, Seoul National University, Seoul, South Korea.,Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
| | - Peter D Wearden
- Cardiothoracic Surgery, Nemours Children's Hospital, Orlando, FL, USA
| | - Kenneth J Smith
- Section of Decision Sciences, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian Feingold
- Pediatrics, Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion Floor 5, Pittsburgh, PA, 15224, USA.,Clinical and Translational Research, University of Pittsburgh, Pittsburgh, PA, USA
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8
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Left Ventricular Device Implantation Impacts on Hospitalisation Rates, Length of Stay and Out of Hospital Time. Heart Lung Circ 2018; 27:708-715. [DOI: 10.1016/j.hlc.2017.06.717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/15/2017] [Accepted: 06/02/2017] [Indexed: 11/23/2022]
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9
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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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10
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Chew DS, Manns B, Miller RJ, Sharma N, Exner DV. Economic Evaluation of Left Ventricular Assist Devices for Patients With End Stage Heart Failure Who Are Ineligible for Cardiac Transplantation. Can J Cardiol 2017; 33:1283-1291. [DOI: 10.1016/j.cjca.2017.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/18/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022] Open
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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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12
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In Vivo Evaluation of a Pneumatic Extracorporeal Ventricular Assist Device for up to 90 Day Support. ASAIO J 2016; 62:697-703. [PMID: 27442861 DOI: 10.1097/mat.0000000000000417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In a previous study, we showed that the Vitalmex Extracorporeal Ventricular Assist Device-Pneumatic (EVAD-P)-a low-cost, pneumatically actuated, pulsatile blood pump-is easy to implant and safe for short-term in vivo support (30 ± 5 days). In the current study, we included additional 30 day experiments and assessed the safety and durability of the EVAD-P for up to 90 days of support. Using the same surgical procedure as in the previous study, we implanted the device into 14 healthy sheep. Group I subjects (n = 7) were evaluated for up to 30 days, and group II (n = 2) and group III (n = 5) subjects were evaluated for up to 49 and 93 days, respectively. After a system redesign, two of the five sheep in group III reached the scheduled end-point without device-related problems at a fixed beat rate of 56 bpm, a stroke volume (SV) of 58.0 ± 2.3 ml, and a flow of 3.5 ± 0.2 L/min. This study shows that the EVAD-P can provide safe pulsatile mechanical circulatory support (MCS) for up to 93 days. To further confirm that the system can consistently provide MCS for this duration, additional studies are recommended.
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Tseng CCS, Ramjankhan FZ, de Jonge N, Chamuleau SAJ. Advanced Strategies for End-Stage Heart Failure: Combining Regenerative Approaches with LVAD, a New Horizon? Front Surg 2015; 2:10. [PMID: 25905105 PMCID: PMC4387859 DOI: 10.3389/fsurg.2015.00010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/07/2015] [Indexed: 12/15/2022] Open
Abstract
Despite the improved treatment of cardiovascular diseases, the population with end-stage heart failure (HF) is progressively growing. The scarcity of the gold standard therapy, heart transplantation, demands novel therapeutic approaches. For patients awaiting transplantation, ventricular-assist devices have been of great benefit on survival. To allow explantation of the assist device and obviate heart transplantation, sufficient and durable myocardial recovery is necessary. However, explant rates so far are low. Combining mechanical circulatory support with regenerative therapies such as cell (-based) therapy and biomaterials might give rise to improved long-term results. Although synergistic effects are suggested with mechanical support and stem cell therapy, evidence in both preclinical and clinical setting is lacking. This review focuses on advanced and innovative strategies for the treatment of end-stage HF and furthermore appraises clinical experience with combined strategies.
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Affiliation(s)
- Cheyenne C S Tseng
- Department of Cardiology, Division Heart and Lungs, University Medical Center , Utrecht , Netherlands ; Interuniversity Cardiology Institute of the Netherlands , Utrecht , Netherlands
| | - Faiz Z Ramjankhan
- Department of Cardio-thoracic Surgery, Division Heart and Lungs, University Medical Center , Utrecht , Netherlands
| | - Nicolaas de Jonge
- Department of Cardiology, Division Heart and Lungs, University Medical Center , Utrecht , Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Division Heart and Lungs, University Medical Center , Utrecht , Netherlands
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Manintveld OC. Left ventricular assist device for end-stage heart failure: results of the first LVAD destination program in the Netherlands : Towards LVAD destination therapy in the Netherlands? Neth Heart J 2015; 23:100-1. [PMID: 25315846 PMCID: PMC4315786 DOI: 10.1007/s12471-014-0609-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- O C Manintveld
- Thoraxcenter, Department of Cardiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands,
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15
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Neyt M, Van den Bruel A, Smit Y, De Jonge N, Vlayen J. The cost-utility of left ventricular assist devices for end-stage heart failure patients ineligible for cardiac transplantation: a systematic review and critical appraisal of economic evaluations. Ann Cardiothorac Surg 2014; 3:439-49. [PMID: 25452904 DOI: 10.3978/j.issn.2225-319x.2014.09.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 08/25/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND A health technology assessment (HTA) of left ventricular assist devices (LVADs) as destination therapy in patients with end-stage heart failure was commissioned by the Dutch Health Care Insurance Board [College voor Zorgverzekeringen (CVZ)]. In this context, a systematic review of the economic literature was performed to assess the procedure's value for money. METHODS A systematic search (updated in December 2013) for economic evaluations was performed by consulting various databases: the HTA database produced by the Centre for Reviews and Dissemination (CRD HTA), websites of HTA institutes, CRD's National Health Service Economic Evaluation Database (NHS EED), Medline (OVID) and EMBASE. No time or language restrictions were imposed and pre-defined selection criteria were used. The two-step selection procedure was performed by two people. References of the selected studies were checked for additional relevant citations. RESULTS Six relevant studies were selected. Four economic evaluations relied on the results of the REMATCH trial to compare a pulsatile-flow LVAD with optimal medical therapy (OMT). These evaluations were performed before the publication of the HeartMate II (HM-II) Destination Therapy Trial which compared a pulsatile-flow with a continuous-flow LVAD. Two more recent economic evaluations combined the results of both trials to make an indirect comparison of a continuous-flow LVAD with OMT. In all studies, the largest part of the incremental cost was due to the reimplantation cost of an LVAD, with a device cost of €58,000-€75,000 and about €55,000 for the surgical procedure. The survival gain was highest with a continuous-flow LVAD, up to about three life-years gained (LYG) versus OMT in the most optimistic study. Quality of life (QoL) was improved but measures with a generic utility instrument were lacking, making estimates on quality-adjusted life-years (QALYs) gained more uncertain. Incremental cost-effectiveness ratios of the two most recent studies were on average €107,600 and $198,184 (ca.€145,800) per QALY gained. CONCLUSIONS Although LVAD destination therapy improves survival and QoL, it remains questionable as to whether it offers value for money. This conclusion may alter if the price of the device/procedure decreases sufficiently, in combination with further improved outcomes for mortality, adverse events and QoL.
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Affiliation(s)
- Mattias Neyt
- 1 ME-TA, Medical Evaluation and Technology Assessment, Belgium ; 2 Independent researcher, the Netherlands ; 3 Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ann Van den Bruel
- 1 ME-TA, Medical Evaluation and Technology Assessment, Belgium ; 2 Independent researcher, the Netherlands ; 3 Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Yolba Smit
- 1 ME-TA, Medical Evaluation and Technology Assessment, Belgium ; 2 Independent researcher, the Netherlands ; 3 Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Nicolaas De Jonge
- 1 ME-TA, Medical Evaluation and Technology Assessment, Belgium ; 2 Independent researcher, the Netherlands ; 3 Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joan Vlayen
- 1 ME-TA, Medical Evaluation and Technology Assessment, Belgium ; 2 Independent researcher, the Netherlands ; 3 Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
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Fantidis P, Sánchez E, Tarhini I, Khan I, Pineda T, Corrales JA, González JR. Left ventricular assist devices in patients with end-stage heart failure: suggestion of an alternative treatment based on clinically well-known concepts. Angiology 2014; 65:861-8. [PMID: 24482491 DOI: 10.1177/0003319713518838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Encouraging results were obtained by using left ventricular assist devices (LVADs) in patients with end-stage heart failure (HF) that exhibits extremely high mortality and who were not candidates for heart transplantation. By using this so-called destination therapy (DT), a substantial percentage of these patients achieved sufficient improvement in cardiac function to permit the explantation of the device. The combination of mechanical and pharmacological therapy increased the frequency and durability of myocardial recovery as compared with other therapeutic approaches. Although cardiac transplantation, LVADs, and cardiac resynchronization therapy have provided a major advance in DT, their limitations stimulate the search for alternative therapies. We discuss the limitations of these 3 treatment options for end-stage HF. Also, we propose and discuss the possible advantages of a new intracorporeal procedure that works continuously as intraaortic balloon counterpulsation without an extracorporeal or intracorporeal computer-controlled mechanism.
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Affiliation(s)
- Panayotis Fantidis
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - Eladio Sánchez
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - Ibrahim Tarhini
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - Ijaz Khan
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - Tomas Pineda
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - Juan Antonio Corrales
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
| | - José Ramón González
- Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain
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