Cost-Effectiveness of Ventricular Assist Device Destination Therapy for Advanced Heart Failure in Duchenne Muscular Dystrophy

Pediatric Cardiology
Defne A MagnettaBrian Feingold

Abstract

Destination ventricular assist device therapy (DT-VAD) is well accepted in select adults with medically refractory heart failure (HF) who are not transplant candidates; however, its use in younger patients with progressive diseases is unclear. We sought to evaluate the cost-effectiveness of DT-VAD in Duchenne muscular dystrophy (DMD) patients with advanced HF. We created a Markov-state transition model (5-year horizon) to compare survival, costs, and quality of life (QOL) between medical management and DT-VAD in DMD with advanced HF. Model input parameters were derived from the literature. We used sensitivity analyses to explore uncertainty around model assumptions. DT-VAD had higher costs ($435,602 vs. $125,696), survival (3.13 vs. 0.60 years), and quality-adjusted survival (1.99 vs. 0.26 years) than medical management. The incremental cost-effectiveness ratio (ICER) for DT-VAD was $179,086 per quality-adjusted life year (QALY). In sensitivity analyses that were widely varied to account for uncertainty in model assumptions, the DT-VAD strategy generally remained more costly and effective than medical management. Only when VAD implantation costs were <$113,142 did the DT-VAD strategy fall below the $100,000/QALY willingness-to-...Continue Reading

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Citations

Dec 8, 2019·Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation·Shelagh M SzaboKatherine L Gooch
Jul 4, 2020·International Journal of Technology Assessment in Health Care·Sarah FontenayNicolas Martelli
May 16, 2019·Pediatric Cardiology·Christopher KnollAndrew Y Shin
Oct 7, 2020·Journal of Clinical Medicine·Rachele AdorisioAntonio Amodeo
Jun 14, 2021·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Mirre ScholteJanneke P C Grutters

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