Left Ventricular Assist Devices: Balancing Quality of Life and Cost
LVADs increase quality of life for patients with advanced heart failure, but also increase lifetime costs.
HealthDay News – Left ventricular assist devices (LVADs) improve quality of life in ambulatory patients with advanced heart failure, but increase lifetime costs, according to a study published online in JACC: Heart Failure.
Jacqueline Baras Shreibati, MD, from the Stanford University School of Medicine in California, and colleagues examined the cost-effectiveness of LVADs in ambulatory patients with advanced heart failure. The costs of care were determined among Medicare beneficiaries before and after LVAD implant in 2009 to 2010. These costs and efficacy data from the literature were used in a Markov model to project the incremental cost-effectiveness ratio (ICER) of destination LVAD therapy vs medical management.
The researchers found that LVAD implant had a mean cost of $175,420. The mean cost of readmission was significantly lower before vs after LVAD ($12,377 vs $19,465; P <.001), while similar monthly outpatient costs were seen ($3,364 vs $2,974; P =.54). Compared with medical management, LVAD increased quality-adjusted life-years (4.41 vs 2.67), readmissions (13.03 vs 6.35), and costs ($726,200 vs $361,800) in the lifetime simulation model, yielding an ICER of $209,400 per quality-adjusted life-year gained and $507,400 per life-year gained. These results were sensitive to LVAD readmission rates and costs of outpatient care; if these parameters were 50% lower the ICER would be $86,900.
"LVADs may provide good value if outpatient costs and adverse events can be reduced," the authors wrote.
Disclosures: Several authors disclosed financial ties to the medical device industry.
Shreibati JB, Goldhaber-Fiebert JD, Banerjee D, Owens DK, Hlatky MA. Cost-effectiveness of left ventricular assist devices in ambulatory patients with advanced heart failure [Published online January 11, 2017]. JACC Heart Fail. doi:10.1016/j.jchf.2016.09.008.