title: Preliminary report on the cost effectiveness of ventricular assist devices.
abstract: The aim of the present study was to perform a cost-effectiveness analysis (CEA) of ventricular assist devices (VAD) implantation surgery in the Japanese medical reimbursement system. The study group consisted of thirty-seven patients who had undergone VAD implantation surgery for dilated cardiomyopathy (n = 25; 67.6 %) or hypertrophic cardiomyopathy (n = 4; 10.8 %), and others (n = 8; 21.6 %). Quality-adjusted life years (QALYs) were calculated using the utility score and years of life. Medical reimbursement bills were chosen as cost indices. The observation period was the 12-month period after surgery. Then, the incremental cost-effectiveness ratio was calculated according to the VAD type. In addition, the prognosis after 36 months was estimated on the basis of the results obtained using the Markov chain model. The mean preoperative INTERMACS profile score was 2.35 ± 0.77. Our results showed that the utility score, which indicates the effectiveness of VAD implantation surgery, improved by 0.279 ± 0.188 (ΔQALY, p < 0.05). The cost of VAD implantation surgery was 313,282 ± 25,275 (ΔUS$/year) on the basis of medical reimbursement bills associated with therapeutic interventions. The calculated result of CEA was 364,501 ± 190,599 (ΔUS$/QALY). The improvement in the utility score was greater for implantable versus extracorporeal VADs (0.233 ± 0.534 vs. 0.371 ± 0.238) and ICER was 303,104 (ΔUS$/ΔQALY). Furthermore, when we estimated CEA for 36 months, the expected baseline value was 102,712 (US$/QALY). Therefore, VAD implantation surgery was cost effective considering the disease specificities.
authors.affiliation: Department of Health Care Economics and Industrial Policy, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. takura@heip.med.osaka-u.ac.jp.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takura
authors.affiliation: Department of Therapeutic Strategy for Heart Failure, Faculty of Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
authors.affiliation: Department of Cardiovascular Surgery, Clinical Medicine, Faculty of Medical Science, Kyushu University, Fukuoka, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tominaga
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagawa
authors.affiliation: Department of Cardiovascular Surgery, Clinical Medicine, Faculty of Medical Science, Kyushu University, Fukuoka, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Tanoue
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000191:economics* / Q000601:surgery; D002312:Cardiomyopathy, Hypertrophic / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D006353:Heart-Assist Devices / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years
keywords: Cost effectiveness; End-stage heart failure; Markov chain model; Quality-adjusted life years; Ventricular assist devices