Saygın Avşar, Tuba;
Jackson, Louise;
Barton, Pelham;
Beese, Sophie;
Lim, Hoong S;
Quinn, David;
Price, Malcolm;
(2024)
Cost-effectiveness of Left Ventricular Assist Devices (LVADs) as destination therapy in the UK: An economic modelling study.
PLOS ONE
, 19
(12)
, Article e0312912. 10.1371/journal.pone.0312912.
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Abstract
OBJECTIVES: Left Ventricular Assist Devices (LVADs) for destination therapy (DT) are used in many countries but in some, like the UK, LVADs are not commissioned due to uncertainty around their cost-effectiveness. Existing economic evaluations of LVADs for these patients have limitations. This study aimed to estimate the cost-effectiveness of LVADs as destination therapy, compared to optimal medical therapy, in the UK. METHODS: A cost-utility analysis from a UK healthcare perspective was conducted, using a Markov model. The model incorporated the impact of major events and complications. Sub-group analyses considered different severities of heart failure on cost-effectiveness. Uncertainty was measured in deterministic and probabilistic sensitivity analyses. RESULTS: LVAD produced additional 2.78 (95% CI 2.46-3.14) QALYs at an incremental cost of £152,329 (95% CI £125,665 - £181,812) compared to medical management, giving an incremental cost-effectiveness ratio (ICER) of £54,748 per QALY. The ICER remained above the accepted thresholds of cost-effectiveness in the UK if a small proportion of patients receiving LVAD becomes eligible for a heart transplant and for all subgroups based on heart failure severity. The deterministic sensitivity analysis showed that the ongoing outpatient costs had a significant impact on the results. CONCLUSIONS: Our analysis found that LVADs are not cost-effective as destination therapy in the UK if a willingness to pay threshold of £50,000 per QALY gained or disease severity modifiers, were applied. Robust data on ongoing costs for LVAD and medical management are needed.
| Type: | Article |
|---|---|
| Title: | Cost-effectiveness of Left Ventricular Assist Devices (LVADs) as destination therapy in the UK: An economic modelling study |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1371/journal.pone.0312912 |
| Publisher version: | https://doi.org/10.1371/journal.pone.0312912 |
| Language: | English |
| Additional information: | Copyright © 2024 Saygın Avşar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
| Keywords: | Cost-effectiveness analysis, Heart failure, Medical practice management, Medical risk factors, Cardiac transplantation, Health economics, Outpatients, Quality of life |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10201373 |
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