Abstract 12375: Cost Effectiveness of Continuous-Flow Left Ventricular Assist Device as Destination Therapy in Advanced Heart Failure
Background: Continuous flow left ventricular assist devices (CF-LVAD) have become the dominant devices implanted for mechanical circulatory support. CF-LVADs improve survival and quality of life while reducing implantation cost relative to pulsatile flow (PF) LVADs. The cost-effectiveness of CF-LVADs compared to optimal medical therapy (OMM) and PF-LVADs has not been assessed.
Methods: A Markov model was adapted from the 2002 Blue Cross Blue Shield Technology Evaluation Center (BCBS TEC) assessment with updated parameter estimates and a 5-year time horizon. Survival and NYHA functional class assessment for OMM patients (pts) were derived from the REMATCH trial and re-hospitalization rates were obtained from the Medicare dataset. Functional class, re-hospitalization, device replacement and survival rates for the CF-LVAD pts were derived from the HeartMate II destination therapy trial. The cost of CF-LVAD implantation was based upon hospital claims data from a subset of pts (n=98). Medicare prospective payments for heart failure were used to approximate the costs of hospital care in the OMM cohort. The monthly cost for outpatient services was derived from REMATCH and added to both LVAD and OMM pts. All costs were adjusted to 2009 US dollars.
Results: The 5 year cost for CF-LVAD patients exceeded that of OMM ($342,136 vs. $29,292). However, compared to OMM, LVAD significantly improved quality-adjusted life years (QALY; 1.90 vs. 0.33) and life years (LY; 2.53 vs. 0.59). CF-LVAD led to an incremental cost effectiveness ratio (ICER) of $199,540/QALY and $161,374/LY, a 75% reduction in the ICER compared to the BCBS TEC ($802,674/QALY). ICER was most sensitive to the cost of device implantation and re-hospitalization as well as long-term survival.
Conclusions: The cost-effectiveness of LVADs has improved significantly over time. This change is explained by significant improvements in survival, functional status and reduction in implantation costs relative to the PF-LVAD.
- © 2010 by American Heart Association, Inc.