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ESC Heart Fail. 2018 Feb;5(1):75-86. doi: 10.1002/ehf2.12194. Epub 2017 Jul 25.

Cost-effectiveness of left ventricular assist devices for patients with end-stage heart failure: analysis of the French hospital discharge database.

Author information

1
Health Economics and Outcome Research (HEOR) Department, ClinSearch, Malakoff, France.
2
Hôpital Marie Lannelongue, Le Plessis-Robinson, France.

Abstract

AIMS:

Although left ventricular assist devices (LVADs) are currently approved for coverage and reimbursement in France, no French cost-effectiveness (CE) data are available to support this decision. This study aimed at estimating the CE of LVAD compared with medical management in the French health system.

METHODS AND RESULTS:

Individual patient data from the 'French hospital discharge database' (Medicalization of information systems program) were analysed using Kaplan-Meier method. Outcomes were time to death, time to heart transplantation (HTx), and time to death after HTx. A micro-costing method was used to calculate the monthly costs extracted from the Program for the Medicalization of Information Systems. A multistate Markov monthly cycle model was developed to assess CE. The analysis over a lifetime horizon was performed from the perspective of the French healthcare payer; discount rates were 4%. Probabilistic and deterministic sensitivity analyses were performed. Outcomes were quality-adjusted life years (QALYs) and incremental CE ratio (ICER). Mean QALY for an LVAD patient was 1.5 at a lifetime cost of €190 739, delivering a probabilistic ICER of €125 580/QALY [95% confidence interval: 105 587 to 150 314]. The sensitivity analysis showed that the ICER was mainly sensitive to two factors: (i) the high acquisition cost of the device and (ii) the device performance in terms of patient survival.

CONCLUSIONS:

Our economic evaluation showed that the use of LVAD in patients with end-stage heart failure yields greater benefit in terms of survival than medical management at an extra lifetime cost exceeding the €100 000/QALY. Technological advances and device costs reduction shall hence lead to an improvement in overall CE.

KEYWORDS:

Cost-effectiveness; Costs; Incremental cost-effectiveness ratio; Left ventricular assist devices; PMSI

PMID:
28741873
PMCID:
PMC5793974
DOI:
10.1002/ehf2.12194
[Indexed for MEDLINE]
Free PMC Article

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