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Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom

AIMS: Continuous‐flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end‐stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequently used...

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Autores principales: Schueler, Stephan, Silvestry, Scott C., Cotts, William G., Slaughter, Mark S., Levy, Wayne C., Cheng, Richard K., Beckman, Jennifer A., Villinger, Jonas, Ismyrloglou, Eleni, Tsintzos, Stelios I., Mahr, Claudius
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318455/
https://www.ncbi.nlm.nih.gov/pubmed/34047072
http://dx.doi.org/10.1002/ehf2.13401
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author Schueler, Stephan
Silvestry, Scott C.
Cotts, William G.
Slaughter, Mark S.
Levy, Wayne C.
Cheng, Richard K.
Beckman, Jennifer A.
Villinger, Jonas
Ismyrloglou, Eleni
Tsintzos, Stelios I.
Mahr, Claudius
author_facet Schueler, Stephan
Silvestry, Scott C.
Cotts, William G.
Slaughter, Mark S.
Levy, Wayne C.
Cheng, Richard K.
Beckman, Jennifer A.
Villinger, Jonas
Ismyrloglou, Eleni
Tsintzos, Stelios I.
Mahr, Claudius
author_sort Schueler, Stephan
collection PubMed
description AIMS: Continuous‐flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end‐stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequently used as an LVAD indication across other major European countries and the United States, with consistent improvements in quality‐of‐life and longevity, National Health Service (NHS) England does not currently fund DT, mainly due to concerns over cost‐effectiveness. On the basis of the recently published ENDURANCE Supplemental Trial studying DT patients, we assessed for the first time the cost‐effectiveness of DT LVADs compared with medical management (MM) in the NHS England. METHODS AND RESULTS: We developed a Markov multiple‐state economic model using NHS cost data. LVAD survival and adverse event rates were derived from the ENDURANCE Supplemental Trial. MM survival was based on Seattle Heart Failure Model estimates in the absence of contemporary clinical trials for this population. Incremental cost‐effectiveness ratios (ICERs) were calculated over a lifetime horizon. A discount rate of 3.5% per year was applied to costs and benefits. Deterministic ICER was £46 207 per quality‐adjusted life year (QALY). Costs and utilities were £204 022 and 3.27 QALYs for the LVAD arm vs. £77 790 and 0.54 QALYs for the MM arm. Sensitivity analyses confirmed robustness of the primary analysis. CONCLUSIONS: The implantation of the HeartWare™ HVAD™ System in patients ineligible for cardiac transplantation as DT is a cost‐effective therapy in the NHS England healthcare system under the end‐of‐life willingness‐to‐pay threshold of £50 000/QALY, which applies for VAD patients.
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spelling pubmed-83184552021-07-31 Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom Schueler, Stephan Silvestry, Scott C. Cotts, William G. Slaughter, Mark S. Levy, Wayne C. Cheng, Richard K. Beckman, Jennifer A. Villinger, Jonas Ismyrloglou, Eleni Tsintzos, Stelios I. Mahr, Claudius ESC Heart Fail Original Research Articles AIMS: Continuous‐flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end‐stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequently used as an LVAD indication across other major European countries and the United States, with consistent improvements in quality‐of‐life and longevity, National Health Service (NHS) England does not currently fund DT, mainly due to concerns over cost‐effectiveness. On the basis of the recently published ENDURANCE Supplemental Trial studying DT patients, we assessed for the first time the cost‐effectiveness of DT LVADs compared with medical management (MM) in the NHS England. METHODS AND RESULTS: We developed a Markov multiple‐state economic model using NHS cost data. LVAD survival and adverse event rates were derived from the ENDURANCE Supplemental Trial. MM survival was based on Seattle Heart Failure Model estimates in the absence of contemporary clinical trials for this population. Incremental cost‐effectiveness ratios (ICERs) were calculated over a lifetime horizon. A discount rate of 3.5% per year was applied to costs and benefits. Deterministic ICER was £46 207 per quality‐adjusted life year (QALY). Costs and utilities were £204 022 and 3.27 QALYs for the LVAD arm vs. £77 790 and 0.54 QALYs for the MM arm. Sensitivity analyses confirmed robustness of the primary analysis. CONCLUSIONS: The implantation of the HeartWare™ HVAD™ System in patients ineligible for cardiac transplantation as DT is a cost‐effective therapy in the NHS England healthcare system under the end‐of‐life willingness‐to‐pay threshold of £50 000/QALY, which applies for VAD patients. John Wiley and Sons Inc. 2021-05-27 /pmc/articles/PMC8318455/ /pubmed/34047072 http://dx.doi.org/10.1002/ehf2.13401 Text en © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research Articles
Schueler, Stephan
Silvestry, Scott C.
Cotts, William G.
Slaughter, Mark S.
Levy, Wayne C.
Cheng, Richard K.
Beckman, Jennifer A.
Villinger, Jonas
Ismyrloglou, Eleni
Tsintzos, Stelios I.
Mahr, Claudius
Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom
title Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom
title_full Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom
title_fullStr Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom
title_full_unstemmed Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom
title_short Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom
title_sort cost‐effectiveness of left ventricular assist devices as destination therapy in the united kingdom
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318455/
https://www.ncbi.nlm.nih.gov/pubmed/34047072
http://dx.doi.org/10.1002/ehf2.13401
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