Cost-utility analysis of direct VAD versus double bridges to heart transplantation in patients with refractory heart failure

Object This study compared the cost-utility of direct ventricular assist device (VAD) versus double bridges, extracorporeal membrane oxygenation (ECMO) before VAD, to heart transplantation in patients with refractory heart failure. Materials and methods From a health payer perspective, a Markov model was developed. The cycle length was one month and the time horizon was a lifetime. Probabilities and direct cost data were calculated from a nationwide claim database. Utility inputs were adopted from published sources. The utility was expressed as quality adjusted life years (QALYs). Both costs and utility were discounted by an annual rate of 3%. Deterministic and probabilistic sensitivity analyses were performed to test the stability of the model. Results The direct VAD group had less life time costs (USD 95,910] v. USD 129,516) but higher life time QALYs than the double bridges group (1.73 vs. 0.89). The sensitivity analysis revealed that the direct VAD group consistently had lower cost and higher QALYs during all variations in model parameters. The probability that direct VAD was cost-effective exceeded 75% at any levels of willing-to-pay. Conclusion From a health-insurance payer perspective, direct VAD bridge to heart transplantation appeared to be more cost-effective than double bridges in patients with refractory heart failure. This article is protected by copyright. All rights reserved.