title: Cost-effectiveness of continuous-flow left ventricular assist devices.
abstract: OBJECTIVE
  Mechanical circulatory support through left ventricular assist devices (LVADs) improves survival and quality of life for patients with end-stage heart failure who are ineligible for cardiac transplantation. Our aim was to calculate the cost-effectiveness of continuous-flow LVADs.
  
  
  METHODS
  A cost-utility analysis from a societal perspective was performed. A lifetime Markov model was set up in which continuous-flow LVAD was compared with optimal medical therapy (OMT). The treatment effect was modeled indirectly combining the results of the REMATCH trial comparing OMT with a pulsatile-flow LVAD and the HeartMate II Destination Therapy Trial comparing a pulsatile-flow LVAD with a continuous-flow LVAD. Cost data were based on real-world financial data of sixty-nine patients with a HeartMate II implantation from the University Medical Centre Utrecht (the Netherlands). One-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Comparing the continuous-flow HeartMate II with OMT, 3.23 (95 percent confidence interval [CI], 2.18-4.49) life-years were gained (LYG) or 2.83 (95 percent CI, 1.91-3.90) quality-adjusted life-years (QALYs). The cost of an LVAD implant was approximately €126,000, of which the device itself represented the largest cost, being €70,000. Total incremental costs amounted to €299,100 (95 percent CI, 190,500-521,000). This resulted in an incremental cost-effectiveness ratio of €94,100 (95 percent CI, 59,100-160,100) per LYG or €107,600 (95 percent CI, 66,700-181,100) per QALY. Sensitivity analyses showed these results were robust.
  
  
  CONCLUSIONS
  Although LVAD destination therapy improves survival and quality of life, it remains a relatively expensive intervention which renders the reimbursement of this therapy questionable.
authors.affiliation: ME-TA, Medical Evaluation and Technology Assessment, Belgium. mattias.neyt@me-ta.eu
authors.forename: Mattias
authors.initials: M
authors.lastname: Neyt
authors.forename: Ann
authors.initials: A
authors.lastname: Van den Bruel
authors.forename: Yolba
authors.initials: Y
authors.lastname: Smit
authors.forename: Nicolaas
authors.initials: N
authors.lastname: De Jonge
authors.forename: Michiel
authors.initials: M
authors.lastname: Erasmus
authors.forename: Diederik
authors.initials: D
authors.lastname: Van Dijk
authors.forename: Joan
authors.initials: J
authors.lastname: Vlayen
mesh_terms: D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000601:surgery*