Comparative cost-effectiveness of the Heart Ware versus Heart Mate II left ventricular assist devices used in the United Kingdom National Health Service bridge-to-transplant program for patients with heart failure

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:33

Article

Pulikottil-Jacob, Ruth¹  Suri, Gaurav¹  Connock, Martin¹  Kandala, Ngianga-Bakwin¹  Sutcliffe, Paul¹  Maheswaran, Hendramoorthy¹  Banner, Nicholas R.^2,3,4  Clarke, Aileen¹ 

[1] Univ Warwick, Warwick Med Sch, Div Hlth Sci, Coventry CV4 7AL, W Midlands, England

[2] Royal Brompton & Harefield NHS Fdn Trust, Heart Failure Care Grp, London, England

[3] Univ London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, Inst Cardiovasc Med & Sci, London SW7 2AZ, England

[4] Royal Coll Surg London, Clin Effectiveness Unit, London, England

关键词: left ventricular assist device;    heart failure;    bridge to transplant;    clinical effectiveness;    cost-effectiveness analysis;    economic model;   

DOI  :  10.1016/j.healun.2014.01.003

来源: Elsevier

【 摘 要 】

BACKGROUND: Patients with advanced heart failure may receive a left ventricular assist device (LVAD) as part of a bridge-to-transplant (BIT) strategy. The United Kingdom National Health Service (UK NHS) has financed a BIT program in which the predominant LVADs used have been the HeartMate II (HM II; Thoratec, Pleasanton, CA) and HeartWare (HW; HeartWare International, Inc. Framingham, MA). We aimed to compare the cost-effectiveness of the use of these within the NHS program. METHODS: Individual patient data from the UK NHS Blood and Transplant Data Base were analyzed with Kaplan-Meier and competing outcomes methodologies. Outcomes were time to death, time to heart transplant (HT), and cumulative incidences of HT, death on LVAD support, and LVAD explantation. A semi-Markov multistate economic model was built to assess cost-effectiveness. The perspective was from the NHS, discount rates were 3.5%. Outcomes were quality-adjusted life-years (QALYs) and incremental cost (2011 prices in GB) per QALY (ICER) for HW vs HM II. RESULTS: Survival was better with HW support than with HIM Ir. Cumulative incidence of HT was low for both groups (11% at similar to 2 years). HW patients accrued 4.99 lifetime QALYs costing 258,913 pound ($410,970), HM II patients accrued 3.84 QALYs costing 231,871 pound ($368,048); deterministic and probabilistic ICERs for HW vs BM R were 23,530 pound ($37,349) and 20,799 pound ($33,014), respectively. CONCLUSIONS: Patients In the UK BIT program who received the HW LVAD had a better clinical outcome than those who received the BM II, and the HW was more cost-effective. This result needs to be reassessed in a randomized controlled trial comparing the 2 devices. Crown Copyright (C) 2014 Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free