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LVADs improve quality of life, increase lifetime costs in patients with advanced HF
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Patients with advanced HF treated with left ventricular assist devices have improved quality of life and higher survival rates, but frequent readmission and follow-up care substantially increased lifetime costs, according to new data published in JACC: Heart Failure.
“Our analysis suggests that patients with advanced HF who are not dependent on [IV] inotropes would live 0.61 years longer, with improved quality of life and incur an additional $364,400 in lifetime costs if treated with [destination therapy] LVAD rather than medical management,” Jacqueline Baras Shreibati, MD, MS, from the division of cardiovascular medicine, department of medicine, Stanford University School of Medicine, and colleagues wrote.
Researchers documented costs of care for Medicare patients before and after LVAD implantation from 2009 to 2010, which they combined with previously published costs and efficacy data to estimate the cost effectiveness of LVADs in patients with non-inotrope-dependent advanced HF.
Costs were reported as 2016 U.S. dollars. The researchers discounted costs and benefits at 3% annually.
There was a mean LVAD implantation cost of $175,420, Baras Shreibati and colleagues reported.
The mean cost of readmission was $12,377 before LVAD and $19,465 after LVAD (P < .001), but monthly outpatient costs were similar ($3,364 vs. $2,974; P = .54), according to the researchers.
In a lifetime simulation model, compared with medical management, quality-adjusted life-years (QALYs) were increased by LVAD (LVAD, 4.41; medical management, 2.67). LVAD was also associated with increased readmissions (13.03 vs. 6.35) and costs ($726,200 vs. $361,800). This resulted in incremental cost-effectiveness ratio of $209,400 per QALY gained and $597,400 per life-year gained.
Readmission rates and outpatient care costs for patients with LVAD influenced the findings. If those were 50% lower, the incremental cost-effectiveness ratio for LVAD would be $86,900, the researchers wrote.
In a related editorial, Joseph G. Rogers, MD, from the division of cardiology at Duke University, wrote there are a number of caveats that should be addressed.
“This information may not be representative of a contemporary state and does not account for changes in incidence or cost of managing adverse events,” Rogers wrote. “Beyond primary data, the report by Shreibati et al highlights a critically important and deeper question: What are our clinical, temporal and financial tolerances for innovation.” – by Dave Quaile
Disclosure: Baras Shreibati reports no relevant financial disclosures. Three other researchers report financial ties with Acumen, HeartWare, Janssen, Thoratec and Zoll. Rogers reports no relevant financial disclosures.
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