AbstractBack groundEnd -stage heart failure is an increasing problem in the western (developed) countries. It is a major health care issue whose frequency is alarmingly increasing. Heart transplantation has been a gold standard medical treatment for this problem. However, the shortage of organ donation due to the high demand for heart transplantation has led to the use of mechanical assist circulation.Ventricular assist devices (VADs) have become alternative treatments for people with an end –stage heart failure (ESHF). Especially the Left Ventricular Assist Devices (LVADs) are recently introduced as a bridge to heart transplantation for people with an end-stage heart failure until a donor heart is available. The brand of a third generation VentrAssist ® LVAD has been in use in Norway. Economic evaluation of this new intervention is not yet assessed.
Objective: To asses the cost-effectiveness of VentrAssist® LVAD as ‘a bridge’ to heart transplantation (BTT) for patients with an End-Stage Heart Failure (ESHF), when compared with the conventional medical management.
Materials and Methods: Data on the efficacy of the VentrAssist®LVAD is taken from a population based multicentre clinical trail studies, and from a Meta analyses study including the clinical use of VentrAssist ®LVAD. The Norwegian clinic is one of the multicentre clinics included in the study, and the cost data used in this study were taken from the Department of Thoracic and cardio-vascular Surgery the Rikshospitalet, university hospital. This cost data were projected from the Micro- costing study by Mishra et al 2004. The decision Tree Pro Health Care Model 2008 was used to estimate the optimal survival of people with an end-stage heart failure. The costs-effectiveness of using VentrAssist LVAD as a BTT and until one year post HTX was estimated.
Results: This first hand cost-effectiveness study showed that VentrAssit®LVAD is clinically effective. VentrAssistLVAD increases the life of an end –stage heart failure patient by 0.04 with an incremental cost of NOK 0.251M per life year gained until HTX. And it increases life years post HTX until one year by 0. 14 with an incremental cost of NOK 0.392 M per life year gained when compared with the conventional medical management. Though the use of VentrAssist®LVAD increased the length of life for people who do not respond to the conventional medical therapy, its cost is much higher than the current willingness to pay ceiling suggested for the Norwegian health care system.
Key words: End-stage heart failure, Health Technology Assessment, VentrAssist® LVAD, Cost-Effectiveness Analysis, Survival probability, Decision Analytic Model