title: The cost impact of short-term ventricular assist devices and extracorporeal life support systems therapies on the National Health Service in the UK.
abstract: OBJECTIVE
  The objective of the study was to assess the cost of using different blood pumps for short-term ventricular assist device (VAD) and extracorporeal life support (ECLS) systems for cardiac and cardiorespiratory failure in the UK.
  
  
  METHODS
  The cost analysis presented was based on evaluation of the time required to provide circulatory support for the following indications: post-cardiac surgery cardiogenic shock, postacute myocardial infarction cardiogenic shock, deteriorating end-stage heart failure (ESHF) and the ability of different blood pumps to provide support for the necessary duration. The maximum length of support for each device was based on the manufacturers' recommendations. Direct medical cost of each treatment was evaluated only for the period of mechanical circulatory support in adults and children. Only the cost of device, placement and replacement procedures were considered. List prices were used for devices; resource use was based on expert opinion; unit costs were obtained from official UK sources and Wythenshawe hospital, Manchester, UK. Hospital perspective was utilized for analysis. Three VADs were selected for comparison in adults and two in children. Four centrifugal ECLS systems were selected for comparison in adults and two in children.
  
  
  RESULTS
  In both VAD and ECLS indications, the CentriMag® was the least expensive when used for support of patients with end-stage heart failure. Compared with Cardiohelp® for ECLS (which has the same maximum claim duration of support of 30 days), CentriMag® lead to cost savings of £4294 per patient in all three clinical conditions considered. In post-cardiac surgery cardiogenic shock, CentriMag® VAD lead to savings of £5014 per patient compared with BPX-80. Results were robust in one-way sensitivity analysis in comparison with Cardiohelp®.
  
  
  CONCLUSIONS
  CentriMag® and PediVAS® blood pumps can lead to significant cost savings to the National Health Service, when used instead of other pumps for short-term VAD or ECLS treatment.
authors.affiliation: Synergus AB, Danderyd, Sweden oleg.borisenko@synergus.com.
authors.forename: Oleg
authors.initials: O
authors.lastname: Borisenko
authors.affiliation: Scottish Extracorporeal Life Support Service, Royal Hospital for Sick Children, Glasgow, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Wylie
authors.affiliation: Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, UK.
authors.forename: John
authors.initials: J
authors.lastname: Payne
authors.affiliation: Synergus AB, Danderyd, Sweden Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Bjessmo
authors.affiliation: Paediatric and Neonatal ECMO Service, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Smith
authors.affiliation: Glenfield General Hospital, Leicester, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Firmin
authors.affiliation: Department of Cardiothoracic Transplant, Wythenshawe Hospital, Manchester, UK.
authors.forename: Nizar
authors.initials: N
authors.lastname: Yonan
mesh_terms: D000367:Age Factors; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics* / Q000295:instrumentation; D006333:Heart Failure / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011474:Prosthesis Design; D012770:Shock, Cardiogenic / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D013222:State Medicine / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D016277:Ventricular Function, Left
keywords: Cardiogenic; Costs and cost analysis; Extracorporeal membrane oxygenation; Great Britain; Heart-assist devices; Shock