Cost-Effectiveness of Thoracotomy Approach for the Implantation of a Centrifugal Left Ventricular Assist Device

Autor: Stelios I. Tsintzos, Jennifer A. Beckman, Anson Cheung, Wayne C. Levy, Martin Strueber, Scott C. Silvestry, Damian M May, Matthew R. Danter, Eleni Ismyrloglou, Nahush A. Mokadam, Mark S. Slaughter, Claudius Mahr, Richard Cheng, Edwin C. McGee
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Cost effectiveness
medicine.medical_treatment
Cost-Benefit Analysis
Biomedical Engineering
Biophysics
Bioengineering
thoracotomy
030204 cardiovascular system & hematology
bridge-to-transplant
Medicare
Biomaterials
03 medical and health sciences
0302 clinical medicine
medicine
left ventricular assist device
Lung transplantation
Humans
Thoracotomy
cost-effectiveness
Aged
Heart transplantation
Heart Failure
mechanical circulatory support
business.industry
General Medicine
Middle Aged
equipment and supplies
medicine.disease
Markov Chains
United States
Surgery
Quality-adjusted life year
Clinical trial
030228 respiratory system
Ventricular assist device
Heart failure
Adult Circulatory Support
Quality of Life
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
minimally invasive
Heart Transplantation
Female
Quality-Adjusted Life Years
Heart-Assist Devices
business
Zdroj: Asaio Journal
ISSN: 1538-943X
1058-2916
Popis: Supplemental Digital Content is available in the text.
This study reports the first analysis regarding cost-effectiveness of left ventricular assist device (LVAD) implantation via thoracotomy. Cost-effectiveness of LVADs implanted via the traditional surgical approach of sternotomy has been improved through the years because of technological advances, along with understanding the importance of patient selection and postimplant management have on positively affecting outcomes. Given the positive clinical outcomes of the thoracotomy approach, we seek to study the cost-effectiveness of a centrifugal LVAD via this less invasive approach. We developed a Markov model. Survival and quality of life inputs (QALY) for the LVAD arm were based on data from the LATERAL clinical trial. For the Medical Management arm, survival was derived from the Seattle Heart Failure Model. The heart transplant probability was derived from INTERMACS. Survival after heart transplantation used International Society for Heart and Lung Transplantation data. Cost inputs were calculated based on Medicare data and past literature. The incremental cost-effectiveness ratio was found to be $64,632 per quality adjusted life year and $57,891 per life year in the bridge to transplant indication. These results demonstrate further improvement in the overall cost-effectiveness of LVAD therapy and confirm implantation of LVADs via a less invasive approach as being cost-effective.
Databáze: OpenAIRE
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