Cost-Effectiveness of Ventricular Assist Device Therapy as a Bridge to Transplant in Comparison to Non-Bridged Cardiac Recipients
Background—Current available treatment options for advanced heart failure include heart transplantation (HTx) and ventricular assist device (VAD) therapy. This project aimed to evaluate the cost-effectiveness of bridge to transplant (BTT)-VAD relative to direct HTx in transplant eligible patients.
Methods and Results—A Markov model was used to evaluate survival benefits and costs for BTT-VAD versus unbridged HTx recipients. Three different scenarios were considered according to severity of patients' baseline hemodynamic status (high, medium and low risk). Results were presented in terms of survival, costs and cost-effectiveness ratio (CER). Sensitivity analyses were used to analyze uncertainty in model estimates. Over a 20-year time horizon, BTT-VAD therapy increased survival at increased cost relative to non-bridged cardiac transplant recipients: $100,841more and 1.19 increased life years (LY) in high risk patients ($84,964/LY), $112,779 more and 1.14 more life years ($99,039/LY) in medium risk patients BTT-VAD therapy, and an additional cost of $144,334 and incremental clinical benefit of 1.21 more life years ($119,574/LY) in low risk patients. The sensitivity analysis estimated a 59%, 54% and 43% chance of BTT-VAD therapy being cost-effective for high, medium and low risk patients at a willingness to pay of $100,000/LY. Subgroup analyses identified that risk of post-VAD and transplant complications, waiting time, renal dysfunction and patient age substantially affect CER.
Conclusions—BTT-VAD therapy is associated with improved survival and increased costs. Based on commonly accepted willingness to pay thresholds, BTT-VAD therapy is likely to be cost-effective relative to unbridged HTx in specific circumstances.
- Received November 27, 2012.
- Revision received April 3, 2013.
- Accepted April 12, 2013.