A Systematic Review of Cost-Effectiveness Analyses of Left Ventricular Assist Devices: Issues and Challenges
Background Advanced heart failure (HF) can be treated conservatively or aggressively, with left ventricular assist devices (LVADs) and heart transplant (HT) being the most aggressive strategies. Objective The goal of this review was to identify, describe, critique and summarize published cost-effect...
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| creator | Schmier, Jordana K. Patel, Jasmine D. Leonhard, Megan J. Midha, Prem A. |
| description | Background
Advanced heart failure (HF) can be treated conservatively or aggressively, with left ventricular assist devices (LVADs) and heart transplant (HT) being the most aggressive strategies.
Objective
The goal of this review was to identify, describe, critique and summarize published cost-effectiveness analyses on LVADs for adults with HF.
Methods
We conducted a literature search using PubMed and ProQuest DIALOG databases to identify English-language publications from 2006 to 2017 describing cost-effectiveness analyses of LVADs and reviewed them against inclusion criteria. Those that met criteria were obtained for full-text review and abstracted if they continued to meet study requirements.
Results
A total of 12 cost-effectiveness studies (13 articles) were identified, all of which described models; they were almost evenly split between those examining LVADs as destination therapy (DT) or as bridge to transplant (BTT). Studies were Markov or semi-Markov models with one- or three-month cycles that followed patients until death. Inputs came from a variety of sources, with the REMATCH trial and INTERMACS registry common clinical data sources, although some publications also used data from studies at their own institutions. Costs were derived from standard sources in many studies but from individual hospital data in some. Inputs for health utilities, which were used in 11 of 12 studies, were generally derived from two studies. None of the studies reported a societal perspective, that is, included non-medical costs such as caregiving.
Conclusions
No study found LVADs to be cost effective for DT or BTT with base case assumptions, although incremental cost-effectiveness ratios met thresholds for cost effectiveness in some probabilistic analyses. With constant improvements in LVADs and expanding indications, understanding and re-evaluating the cost effectiveness of their use will be critical to making treatment decisions. |
| doi_str_mv | 10.1007/s40258-018-0439-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2179226594</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2179226594</sourcerecordid><originalsourceid>FETCH-LOGICAL-c405t-9da723d1fb8e8c8b885ea6ce2cf246c639bef5be4048a2194caec8170ce4dc8a3</originalsourceid><addsrcrecordid>eNp1kU9rGzEQxUVJaRK3H6CXIMill00lrSRLvRnHTQKGQv9dhVY7ajasd1ONNo2_feXabSGQgxjB_OZJ8x4hbzm74IzN36NkQpmK8XJkbavHF-SE87mtuLH66M9dVUorcUxOEe8YE1pb-Yoc16yWSipzQvoF_bLFDBufu0A_w0MHv-gY6XLEXK1ihJC7BxgAkS4G328RcNdeQ8z0Oww5dWHqfaILxA4zvSwCAfADvUGcCuqHli5vfd_D8APwNXkZfY_w5lBn5NvH1dfldbX-dHWzXKyrIJnKlW39XNQtj40BE0xjjAKvA4gQhdRB17aBqBqQTBovuJXBQzB8zgLINhhfz8i7ve59Gn-Wb2S36TBA3_sBxgmdKB4JoZWVBT1_gt6NUyqbFkpoVlspOSsU31MhjYgJortP3canrePM7aJw-yhcicLtonCPZebsoDw1G2j_Tfz1vgBiD2BpFXvS_6efV_0NBTeVZA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2260394410</pqid></control><display><type>article</type><title>A Systematic Review of Cost-Effectiveness Analyses of Left Ventricular Assist Devices: Issues and Challenges</title><source>MEDLINE</source><source>PAIS Index</source><source>SpringerLink Journals - AutoHoldings</source><creator>Schmier, Jordana K. ; Patel, Jasmine D. ; Leonhard, Megan J. ; Midha, Prem A.</creator><creatorcontrib>Schmier, Jordana K. ; Patel, Jasmine D. ; Leonhard, Megan J. ; Midha, Prem A.</creatorcontrib><description>Background
Advanced heart failure (HF) can be treated conservatively or aggressively, with left ventricular assist devices (LVADs) and heart transplant (HT) being the most aggressive strategies.
Objective
The goal of this review was to identify, describe, critique and summarize published cost-effectiveness analyses on LVADs for adults with HF.
Methods
We conducted a literature search using PubMed and ProQuest DIALOG databases to identify English-language publications from 2006 to 2017 describing cost-effectiveness analyses of LVADs and reviewed them against inclusion criteria. Those that met criteria were obtained for full-text review and abstracted if they continued to meet study requirements.
Results
A total of 12 cost-effectiveness studies (13 articles) were identified, all of which described models; they were almost evenly split between those examining LVADs as destination therapy (DT) or as bridge to transplant (BTT). Studies were Markov or semi-Markov models with one- or three-month cycles that followed patients until death. Inputs came from a variety of sources, with the REMATCH trial and INTERMACS registry common clinical data sources, although some publications also used data from studies at their own institutions. Costs were derived from standard sources in many studies but from individual hospital data in some. Inputs for health utilities, which were used in 11 of 12 studies, were generally derived from two studies. None of the studies reported a societal perspective, that is, included non-medical costs such as caregiving.
Conclusions
No study found LVADs to be cost effective for DT or BTT with base case assumptions, although incremental cost-effectiveness ratios met thresholds for cost effectiveness in some probabilistic analyses. With constant improvements in LVADs and expanding indications, understanding and re-evaluating the cost effectiveness of their use will be critical to making treatment decisions.</description><identifier>ISSN: 1175-5652</identifier><identifier>EISSN: 1179-1896</identifier><identifier>DOI: 10.1007/s40258-018-0439-x</identifier><identifier>PMID: 30345458</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adults ; Cardiology ; Cardiovascular disease ; Caregivers ; Cost analysis ; Cost-Benefit Analysis ; Criteria ; Decision making ; Effectiveness ; Female ; Health Administration ; Health care expenditures ; Health Economics ; Heart failure ; Heart transplants ; Humans ; Male ; Markov chains ; Medical treatment ; Medicine ; Medicine & Public Health ; Patients ; Pharmacoeconomics and Health Outcomes ; Prostheses and Implants - economics ; Public Health ; Quality of life ; Quality of Life Research ; Systematic Review ; Transplants & implants ; Ventricular Dysfunction, Left - surgery</subject><ispartof>Applied health economics and health policy, 2019-02, Vol.17 (1), p.35-46</ispartof><rights>Springer Nature Switzerland AG 2018</rights><rights>Copyright Springer Nature B.V. Feb 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-9da723d1fb8e8c8b885ea6ce2cf246c639bef5be4048a2194caec8170ce4dc8a3</citedby><cites>FETCH-LOGICAL-c405t-9da723d1fb8e8c8b885ea6ce2cf246c639bef5be4048a2194caec8170ce4dc8a3</cites><orcidid>0000-0002-4662-8800</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40258-018-0439-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40258-018-0439-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27866,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30345458$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schmier, Jordana K.</creatorcontrib><creatorcontrib>Patel, Jasmine D.</creatorcontrib><creatorcontrib>Leonhard, Megan J.</creatorcontrib><creatorcontrib>Midha, Prem A.</creatorcontrib><title>A Systematic Review of Cost-Effectiveness Analyses of Left Ventricular Assist Devices: Issues and Challenges</title><title>Applied health economics and health policy</title><addtitle>Appl Health Econ Health Policy</addtitle><addtitle>Appl Health Econ Health Policy</addtitle><description>Background
Advanced heart failure (HF) can be treated conservatively or aggressively, with left ventricular assist devices (LVADs) and heart transplant (HT) being the most aggressive strategies.
Objective
The goal of this review was to identify, describe, critique and summarize published cost-effectiveness analyses on LVADs for adults with HF.
Methods
We conducted a literature search using PubMed and ProQuest DIALOG databases to identify English-language publications from 2006 to 2017 describing cost-effectiveness analyses of LVADs and reviewed them against inclusion criteria. Those that met criteria were obtained for full-text review and abstracted if they continued to meet study requirements.
Results
A total of 12 cost-effectiveness studies (13 articles) were identified, all of which described models; they were almost evenly split between those examining LVADs as destination therapy (DT) or as bridge to transplant (BTT). Studies were Markov or semi-Markov models with one- or three-month cycles that followed patients until death. Inputs came from a variety of sources, with the REMATCH trial and INTERMACS registry common clinical data sources, although some publications also used data from studies at their own institutions. Costs were derived from standard sources in many studies but from individual hospital data in some. Inputs for health utilities, which were used in 11 of 12 studies, were generally derived from two studies. None of the studies reported a societal perspective, that is, included non-medical costs such as caregiving.
Conclusions
No study found LVADs to be cost effective for DT or BTT with base case assumptions, although incremental cost-effectiveness ratios met thresholds for cost effectiveness in some probabilistic analyses. With constant improvements in LVADs and expanding indications, understanding and re-evaluating the cost effectiveness of their use will be critical to making treatment decisions.</description><subject>Adults</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Caregivers</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>Criteria</subject><subject>Decision making</subject><subject>Effectiveness</subject><subject>Female</subject><subject>Health Administration</subject><subject>Health care expenditures</subject><subject>Health Economics</subject><subject>Heart failure</subject><subject>Heart transplants</subject><subject>Humans</subject><subject>Male</subject><subject>Markov chains</subject><subject>Medical treatment</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Patients</subject><subject>Pharmacoeconomics and Health Outcomes</subject><subject>Prostheses and Implants - economics</subject><subject>Public Health</subject><subject>Quality of life</subject><subject>Quality of Life Research</subject><subject>Systematic Review</subject><subject>Transplants & implants</subject><subject>Ventricular Dysfunction, Left - surgery</subject><issn>1175-5652</issn><issn>1179-1896</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7TQ</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kU9rGzEQxUVJaRK3H6CXIMill00lrSRLvRnHTQKGQv9dhVY7ajasd1ONNo2_feXabSGQgxjB_OZJ8x4hbzm74IzN36NkQpmK8XJkbavHF-SE87mtuLH66M9dVUorcUxOEe8YE1pb-Yoc16yWSipzQvoF_bLFDBufu0A_w0MHv-gY6XLEXK1ihJC7BxgAkS4G328RcNdeQ8z0Oww5dWHqfaILxA4zvSwCAfADvUGcCuqHli5vfd_D8APwNXkZfY_w5lBn5NvH1dfldbX-dHWzXKyrIJnKlW39XNQtj40BE0xjjAKvA4gQhdRB17aBqBqQTBovuJXBQzB8zgLINhhfz8i7ve59Gn-Wb2S36TBA3_sBxgmdKB4JoZWVBT1_gt6NUyqbFkpoVlspOSsU31MhjYgJortP3canrePM7aJw-yhcicLtonCPZebsoDw1G2j_Tfz1vgBiD2BpFXvS_6efV_0NBTeVZA</recordid><startdate>20190201</startdate><enddate>20190201</enddate><creator>Schmier, Jordana K.</creator><creator>Patel, Jasmine D.</creator><creator>Leonhard, Megan J.</creator><creator>Midha, Prem A.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>4T-</scope><scope>7TQ</scope><scope>7WY</scope><scope>7WZ</scope><scope>7X7</scope><scope>7XB</scope><scope>87Z</scope><scope>88C</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FL</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>BENPR</scope><scope>BEZIV</scope><scope>CCPQU</scope><scope>DHY</scope><scope>DON</scope><scope>DPSOV</scope><scope>DWQXO</scope><scope>FRNLG</scope><scope>FYUFA</scope><scope>F~G</scope><scope>GHDGH</scope><scope>K60</scope><scope>K6~</scope><scope>K9.</scope><scope>KC-</scope><scope>L.-</scope><scope>M0C</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2L</scope><scope>PQBIZ</scope><scope>PQBZA</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4662-8800</orcidid></search><sort><creationdate>20190201</creationdate><title>A Systematic Review of Cost-Effectiveness Analyses of Left Ventricular Assist Devices: Issues and Challenges</title><author>Schmier, Jordana K. ; Patel, Jasmine D. ; Leonhard, Megan J. ; Midha, Prem A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c405t-9da723d1fb8e8c8b885ea6ce2cf246c639bef5be4048a2194caec8170ce4dc8a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adults</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Caregivers</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>Criteria</topic><topic>Decision making</topic><topic>Effectiveness</topic><topic>Female</topic><topic>Health Administration</topic><topic>Health care expenditures</topic><topic>Health Economics</topic><topic>Heart failure</topic><topic>Heart transplants</topic><topic>Humans</topic><topic>Male</topic><topic>Markov chains</topic><topic>Medical treatment</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Patients</topic><topic>Pharmacoeconomics and Health Outcomes</topic><topic>Prostheses and Implants - economics</topic><topic>Public Health</topic><topic>Quality of life</topic><topic>Quality of Life Research</topic><topic>Systematic Review</topic><topic>Transplants & implants</topic><topic>Ventricular Dysfunction, Left - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schmier, Jordana K.</creatorcontrib><creatorcontrib>Patel, Jasmine D.</creatorcontrib><creatorcontrib>Leonhard, Megan J.</creatorcontrib><creatorcontrib>Midha, Prem A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>PAIS Index</collection><collection>Access via ABI/INFORM (ProQuest)</collection><collection>ABI/INFORM Global (PDF only)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ABI/INFORM Global (Alumni Edition)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ABI/INFORM Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>ProQuest Central</collection><collection>Business Premium Collection</collection><collection>ProQuest One Community College</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>Politics Collection</collection><collection>ProQuest Central Korea</collection><collection>Business Premium Collection (Alumni)</collection><collection>Health Research Premium Collection</collection><collection>ABI/INFORM Global (Corporate)</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Business Collection (Alumni Edition)</collection><collection>ProQuest Business Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Politics Collection</collection><collection>ABI/INFORM Professional Advanced</collection><collection>ABI/INFORM Global</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Political Science Database</collection><collection>One Business (ProQuest)</collection><collection>ProQuest One Business (Alumni)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Applied health economics and health policy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schmier, Jordana K.</au><au>Patel, Jasmine D.</au><au>Leonhard, Megan J.</au><au>Midha, Prem A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Systematic Review of Cost-Effectiveness Analyses of Left Ventricular Assist Devices: Issues and Challenges</atitle><jtitle>Applied health economics and health policy</jtitle><stitle>Appl Health Econ Health Policy</stitle><addtitle>Appl Health Econ Health Policy</addtitle><date>2019-02-01</date><risdate>2019</risdate><volume>17</volume><issue>1</issue><spage>35</spage><epage>46</epage><pages>35-46</pages><issn>1175-5652</issn><eissn>1179-1896</eissn><abstract>Background
Advanced heart failure (HF) can be treated conservatively or aggressively, with left ventricular assist devices (LVADs) and heart transplant (HT) being the most aggressive strategies.
Objective
The goal of this review was to identify, describe, critique and summarize published cost-effectiveness analyses on LVADs for adults with HF.
Methods
We conducted a literature search using PubMed and ProQuest DIALOG databases to identify English-language publications from 2006 to 2017 describing cost-effectiveness analyses of LVADs and reviewed them against inclusion criteria. Those that met criteria were obtained for full-text review and abstracted if they continued to meet study requirements.
Results
A total of 12 cost-effectiveness studies (13 articles) were identified, all of which described models; they were almost evenly split between those examining LVADs as destination therapy (DT) or as bridge to transplant (BTT). Studies were Markov or semi-Markov models with one- or three-month cycles that followed patients until death. Inputs came from a variety of sources, with the REMATCH trial and INTERMACS registry common clinical data sources, although some publications also used data from studies at their own institutions. Costs were derived from standard sources in many studies but from individual hospital data in some. Inputs for health utilities, which were used in 11 of 12 studies, were generally derived from two studies. None of the studies reported a societal perspective, that is, included non-medical costs such as caregiving.
Conclusions
No study found LVADs to be cost effective for DT or BTT with base case assumptions, although incremental cost-effectiveness ratios met thresholds for cost effectiveness in some probabilistic analyses. With constant improvements in LVADs and expanding indications, understanding and re-evaluating the cost effectiveness of their use will be critical to making treatment decisions.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>30345458</pmid><doi>10.1007/s40258-018-0439-x</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-4662-8800</orcidid></addata></record> |
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| ispartof | Applied health economics and health policy, 2019-02, Vol.17 (1), p.35-46 |
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| language | eng |
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| source | MEDLINE; PAIS Index; SpringerLink Journals - AutoHoldings |
| subjects | Adults Cardiology Cardiovascular disease Caregivers Cost analysis Cost-Benefit Analysis Criteria Decision making Effectiveness Female Health Administration Health care expenditures Health Economics Heart failure Heart transplants Humans Male Markov chains Medical treatment Medicine Medicine & Public Health Patients Pharmacoeconomics and Health Outcomes Prostheses and Implants - economics Public Health Quality of life Quality of Life Research Systematic Review Transplants & implants Ventricular Dysfunction, Left - surgery |
| title | A Systematic Review of Cost-Effectiveness Analyses of Left Ventricular Assist Devices: Issues and Challenges |
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