A Systematic Review of the Cost-Effectiveness of Long-Term Mechanical Circulatory Support

Jun 1, 2016, 00:00
10.1016/j.jval.2014.12.020
https://www.valueinhealthjournal.com/article/S1098-3015(15)01910-5/fulltext
Title : A Systematic Review of the Cost-Effectiveness of Long-Term Mechanical Circulatory Support
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(15)01910-5&doi=10.1016/j.jval.2014.12.020
First page : 494
Section Title : Systematic Review
Open access? : No
Section Order : 22

Background

Mechanical circulatory support (MCS) is an option for the treatment of medically intractable end-stage heart failure. MCS therapy, however, is resource intensive.

Objective

The purpose of this report was to systematically review the MCS cost-effectiveness literature as it pertains to the treatment of adult patients in end-stage heart failure.

Methods

We conducted a systematic search and narrative review of available cost- effectiveness and cost-utility analyses of MCS in adult patients with end-stage heart failure.

Results

Eleven studies analyzing the cost-effectiveness or cost-utility of MCS were identified. Seven studies focused on bridge to transplantation, three studies focused on destination therapy, and one study presented analyses of both strategies. Two articles evaluated the cost-effectiveness of the HeartMate II (Thoratec Corp., Pleasanton, CA). Incremental cost-effectiveness ratios between MCS and medical management ranged between $85,025 and $200,166 for bridge to transplantation and between $87,622 and $1,257,946 for destination therapy (2012 Canadian dollars per quality-adjusted life-year). Sensitivity analyses indicated that improvements in survival and quality of life and reductions in device and initial hospital-stay costs may improve the cost-effectiveness of MCS.

Conclusions

Current studies suggest that MCS is likely not cost-effective with reference to generally accepted or explicitly stated thresholds. Refined patient selection, complication rates, achieved quality of life, and device/surgical costs, however, could modify the cost-effectiveness of MCS.

Categories :
  • Cardiovascular Disorders
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Economic Evaluation
  • Literature Review & Synthesis
  • Specific Diseases & Conditions
  • Study Approaches
Tags :
  • cost-effectiveness
  • health technology assessment
  • heart-assist devices
Regions :
  • Global
ViH Article Tags :