| Cost-effectiveness analysis of continuous-flow left ventricular assist devices as destination therapy. | |
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MedLine Citation:
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PMID: 22052901 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Continuous-flow left ventricular assist devices (LVADs) have become the dominant devices for mechanical circulatory support, but their cost-effectiveness is undetermined. This study assessed the cost-effectiveness of continuous-flow devices for destination therapy versus optimal medical management in advanced heart failure and compared the results with previous estimates for pulsatile devices. METHODS AND RESULTS: A Markov model was developed to assess cost-effectiveness. Survival, hospitalization rates, quality of life, and cost data were obtained for advanced heart failure patients treated medically or with a continuous-flow LVAD. Rates of clinical outcomes for all patients were obtained from clinical trial databases. Medicare prospective payments were used to estimate the cost of heart failure admissions. The cost of LVAD implantation was obtained prospectively from hospital claims within a clinical trial. Compared with medically managed patients, continuous-flow LVAD patients had higher 5-year costs ($360 407 versus $62 856), quality-adjusted life years (1.87 versus 0.37), and life years (2.42 versus 0.64). The incremental cost-effectiveness ratio of the continuous-flow device was $198 184 per quality-adjusted life year and $167 208 per life year. This equates to a 75% reduction in incremental cost-effectiveness ratio compared with the $802 700 per quality-adjusted life year for the pulsatile-flow device. The results were most sensitive to the cost of device implantation, long-term survival, cost per rehospitalization, and utility associated with patients' functional status. CONCLUSIONS: The cost-effectiveness associated with continuous-flow LVADs for destination therapy has improved significantly relative to the pulsatile flow devices. This change is explained by significant improvements in survival and functional status and reduction in implantation costs. |
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Authors:
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Joseph G Rogers; Robin R Bostic; Kuo B Tong; Rob Adamson; Mark Russo; Mark S Slaughter |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2011-11-03 |
Journal Detail:
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Title: Circulation. Heart failure Volume: 5 ISSN: 1941-3297 ISO Abbreviation: Circ Heart Fail Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-01-18 Completed Date: 2012-04-13 Revised Date: 2012-05-24 |
Medline Journal Info:
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Nlm Unique ID: 101479941 Medline TA: Circ Heart Fail Country: United States |
Other Details:
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Languages: eng Pagination: 10-6 Citation Subset: IM |
Affiliation:
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Division of Cardiology, Duke University, Durham, NC, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cost-Benefit Analysis Heart Failure / economics*, mortality, therapy* Heart-Assist Devices / economics* Humans Insurance, Health, Reimbursement / economics Medicare / economics Prospective Payment System / economics Quality of Life Quality-Adjusted Life Years Survival Rate Treatment Outcome United States |
| Comments/Corrections | |
Comment In:
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Circ Heart Fail. 2012 Mar 1;5(2):e50
[PMID:
22438529
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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