Cost-Utility of LVAD for End-Stage Heart Failure
The evaluations were conducted for the UK, the Netherlands, Italy, and the US (Table 2). Four studies used a Markov model to perform a cost-utility analysis (CUA). The other two evaluations applied an alternative method. The study by Girling et al. identified thresholds for survival parameters which would allow the intervention to be cost effective. The Italian study calculated the value of the intervention based on the additional survival in combination with the societal economic counter value for each month of life saved. All models included a lifelong time horizon. Adang et al. mentioned a three-year horizon, but after 35 months, all patients in the model were deceased. Clegg et al. applied a five-year horizon and all patients were deceased in the 21 quarter. The discount rate for costs and effects usually reflected national guidelines and varied between 3–6% for costs and 1.5–3.5% for effects.
The economic evaluations can be divided in two groups. First, four economic evaluations were performed before the results of the HM-II Destination Therapy trial were published and compared a 1-generation pulsatile LVAD with OMT. Second, two more recent studies were published afterwards and compared a 2-generation continuous-flow LVAD with OMT. The populations reflected the characteristics of the underlying clinical trials (Table 2).
General Information
The evaluations were conducted for the UK, the Netherlands, Italy, and the US (Table 2). Four studies used a Markov model to perform a cost-utility analysis (CUA). The other two evaluations applied an alternative method. The study by Girling et al. identified thresholds for survival parameters which would allow the intervention to be cost effective. The Italian study calculated the value of the intervention based on the additional survival in combination with the societal economic counter value for each month of life saved. All models included a lifelong time horizon. Adang et al. mentioned a three-year horizon, but after 35 months, all patients in the model were deceased. Clegg et al. applied a five-year horizon and all patients were deceased in the 21 quarter. The discount rate for costs and effects usually reflected national guidelines and varied between 3–6% for costs and 1.5–3.5% for effects.
The economic evaluations can be divided in two groups. First, four economic evaluations were performed before the results of the HM-II Destination Therapy trial were published and compared a 1-generation pulsatile LVAD with OMT. Second, two more recent studies were published afterwards and compared a 2-generation continuous-flow LVAD with OMT. The populations reflected the characteristics of the underlying clinical trials (Table 2).